Head Claims
full-time
About the job
Prudential's purpose is to be partners for every life and protectors for every future. Our purpose encourages everything we do by creating a culture in which diversity is celebrated and inclusion assured, for our people, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and we support our people's career ambitions. We pledge to make Prudential a place where you can Connect, Grow, and Succeed.
Role incumbent provides end-to-end operational and supervisory oversight of the Claims team, ensuring policy claims are assessed and settled promptly, fairly and consistently, while protecting the company from fraud, leakage and regulatory, legal, financial and reputational risk.
The role holder will drive and shape a customer-centred claims philosophy, strengthen governance and controls, and use data, technology and capable teams to deliver an efficient claims experience that reinforces trust in the company's promise to policyholders and beneficiaries.
Key Responsibilities
Develop and execute the claims strategy in alignment with the company's business objectives, customer proposition, risk appetite and operational priorities.
Optimize service standards that promote fairness, consistency and sound judgement.
Timely collation of claims data analysis and presentation to the executive management (via the Chief Operations Officer) claims trends, emerging risks, material losses, service performance and required interventions, to aid executive decisions.
Proactively engage and maintain effective relationships with Underwriting, Actuarial, Finance, Legal, Compliance, Risk, Internal Audit, Sales, Customer Service, Technology and Product teams, to uphold seamless claims operations.
Oversee the end-to-end notification, registration, validation, investigation, assessment, approval, repudiation and settlement of claims across individual and group life portfolios.
Ensure claims are handled within approved turnaround times, policy terms, delegated authorities and applicable legal and regulatory requirements.
Oversee complex, contentious, litigated and ex gratia claims, escalating material matters appropriately and documenting the rationale for decisions.
Ensure clear, timely and empathetic communication with claimants, beneficiaries, policyholders, intermediaries and corporate clients, particularly in sensitive situations (e.g. bereavement).
Maintain effective complaint resolution and escalation processes, conduct root cause analysis and translate insights into service improvements.
Uphold and own continuous improvement through claims process redesign, automation, workflow discipline and effective case management, to enhance customer experience and minimize risk exposure.
Ensure compliance with applicable NAICOM, regulations, regulatory guidelines, anti-money laundering requirements, data protection obligations and internal policies.
Maintain robust claims policies, standard operating procedures, decision records, quality assurance reviews and audit trails.
Uphold preventive and detective controls minimize claims leakage, fraud, error, duplicate payments and unauthorised settlements.
Actively coordinate claims investigations and coordinate with Compliance, Legal, Internal Audit, law enforcement and external specialists, where required.
Ensure timely and accurate regulatory, statutory and management reporting (monthly/quarterly, etc), on outstanding claims, ageing, repudiations, complaints, recoveries and material exposures.
Promptly address audit, compliance and regulatory findings and ensure agreed remedial actions are sustained.
Sustain a high performing claims team with clear objectives, appropriate capacity, strong technical capability and disciplined performance management.
Qualifications
Minimum of first degree or equivalence (e.g. B.Sc.) in Insurance, Actuarial, or related courses
Must possess a recognized professional qualification/certification in Insurance (e.g. CIIN or CII) and minimum membership of Associate (ACIIN or ACII)
Experience
Minimum of 10 years of progressive operational experience in life insurance administration, policy processing, or actuarial/claims management.
Minimum of five (5) years' experience (post-professional qualification) in the technical department of an insurance institution.
Demonstrable experience overseeing complex and high value claims, claims governance, fraud risk, litigation, reserving interfaces and reinsurance recoveries.
Strong practical knowledge of the Nigerian life insurance market and the legal and regulatory environment governing claims administration.
Key Competencies
Claims Expertise: Deep and practical knowledge of life claims assessment, policy interpretation, medical and financial evidence, investigation and settlement.
Regulatory and Risk Judgement: Applies sound judgement within legal, regulatory, ethical and risk parameters.
Customer Centricity: Balances compassionate service with disciplined policy and control requirements.
Commercial and Financial Acumen: Understands the impact of claims on profitability, reserves, capital, reinsurance and customer value.
Data-led Decision-Making: Converts claims data into actionable insight and measurable interventions.
Strategic Team Coordination: Sets direction, translates strategy into execution and drives sustainable change.
People Management: Builds capability, accountability and collaboration
Communication and Influence: Communicates complex and sensitive decisions clearly and credibly to diverse stakeholders.
Integrity and Courage: Makes fair, evidence-based decisions and constructively challenges inappropriate outcomes.
Operational Excellence: Establishes disciplined processes, effective controls and a continuous-improvement culture