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Job Description

The role involves managing disability claims complaints in line with the Old Mutual complaints management framework, product rules, policy contract provisions, regulatory requirements and Treating Customers Fairly principles.

The successful candidate will review escalated and complex complaint matters, assess the underlying claim decision and supporting evidence, identify service, process, contractual or communication gaps, and provide clear, fair and well-reasoned complaint outcomes.

The role requires strong written and verbal communication, sound judgement, stakeholder management and the ability to resolve complaints while protecting the interests of customers, clients and the organisation.

Key Result Areas:

Manage disability claims complaints

Manage and resolve disability claims complaints in accordance with the applicable complaints management framework, regulatory requirements, internal standards and service expectations. Ensure that each complaint is acknowledged, investigated, responded to and closed within the required timeframes.

Review claim decisions and complaint merits

Perform a holistic review of the complaint, including the claim decision, medical and occupational evidence, policy contract provisions, correspondence, process history and any new information received. Assess whether the claim decision and complaint outcome are fair, evidence-based, contractually sound and clearly reasoned.

Draft clear and professional complaint responses

Prepare accurate, balanced and professional written responses to complainants, employers, brokers, internal stakeholders and escalation forums. Ensure responses explain the complaint outcome, the evidence considered, the contractual basis for the position taken and any further steps available to the complainant.

Stakeholder communication and collaboration

Engage effectively with claims assessors, technical team leaders, claims management, legal, compliance, clients, brokers and other relevant stakeholders to obtain information, clarify issues and support fair complaint resolution. Maintain constructive relationships through proactive, professional and appropriate communication.

Complaint trend analysis and process improvement

Identify complaint themes, root causes, service failures, communication gaps, process weaknesses and potential training needs. Provide insights and recommendations to support continuous improvement, reduce repeat complaints and improve customer, client and broker experience.

Organisational risk management

Identify, record and escalate operational, legal, reputational, and regulatory risks arising from complaints. Work within established risk management processes and ensure that material concerns are brought to the attention of the appropriate stakeholders.

Regulatory and compliance management

Apply relevant regulatory requirements, internal policies, complaints standards, data privacy principles and codes of conduct when managing complaints. Ensure that complaint records, decisions, correspondence and outcomes are complete, accurate, auditable and aligned to governance expectations.

Operational compliance

Develop and maintain knowledge of the organisation’s processes, product rules, policy contract provisions, referral practices, record keeping requirements and complaints procedures to ensure that own work adheres to required standards.

Personal capability building

Develop own capabilities through assessment, development planning, formal and informal learning, coaching and ongoing engagement with relevant industry, regulatory, legal and complaints management developments.

Role Requirements: Skills, Qualifications and Experience

• Grade 12/Matric
• Completed medical / allied health Degree, e.g. Nursing, Occupational Therapy, Physiotherapy, or relevant claims-related qualification
• Legal qualification would be advantageous
• Minimum 2 years claims assessment, complaints management or related financial services experience
• Disability claims assessment experience in a Group Assurance or Risk environment and GAP product knowledge is highly advantageous
• Complaints management experience is highly advantageous
• Strong understanding of policy contracts, disability definitions, claims evidence requirements and complaint resolution principles
• Well developed interpersonal skills
• Excellent verbal and written communication skills, with the ability to explain complex claims, contractual and complaint issues clearly and professionally
• Excellent attention to detail and ability to produce accurate, balanced and well-reasoned written responses
• Sound analytical, problem solving and decision-making abilities
• Ability to manage sensitive and escalated matters objectively, fairly and professionally
• Ability to work under pressure, manage competing priorities and meet complaint turnaround times
• Computer literate and proficient in MS Office programmes e.g. Word, PowerPoint and Excel
• Work effectively with internal and external colleagues and clients to accomplish organisational and team goals
• Enjoy working in a progressive environment

 

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Skills

Consultative Selling, Customer Complaint Management, Customer Feedback Management, Customer-Focused, Customer Relationship Management (CRM) Software, Customer Service, Customer Service Operations, Customer Understanding, Data Management, Digital Consumer Engagement, Identifying Sales Opportunities, Probing Questions, Sales Data Management, Strengthening Customer Relationships, Upselling

Competencies

Action Oriented

Collaborates

Communicates Effectively

Customer Focus

Decision Quality

Directs Work

Interpersonal Savvy

Manages Complexity

Education

NQF Level 5 - Higher, Advance or Occupational Certificate or equivalent

Closing Date

06 September 2026 , 23:59

The appointment will be made from the designated group in line with the Employment Equity Plan of Old Mutual South Africa and the specific business unit in question.

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