Lets Write Africa's Story Together!

Old Mutual is a firm believer in the African opportunity and our diverse talent reflects this.

Job Description

Ensures that general insurance claims are handled expeditiously and in a professional manner thereby meeting the customer expectations. Manages the claims function with a team of claims assessors and negotiators. Develops the claims policy, procedures, and practices. Evaluates risks with claims, coverage complexity, and those in excess of field approval limits. Provides counsel regarding claims evaluation and coverage.

Responsibilities

Insurance Claims Administration

Review and analyze very complex, high-value insurance claims in line with the organization's claims policies, procedures, and customer service standards. Initiate specialist investigations and engage loss adjusters and/or subject-matter experts where appropriate. Authorize claims within delegated authority and refer complex or unresolved issues to line manager.

Fraud/Financial Crime Management

Develop and deliver specialized fraud prevention and monitoring activities for an area of operations, in line with the organization's fraud management policies and procedures, to enable the prevention of fraud and enable the initiation of loss mitigations and fraud investigations.

Fraud/Financial Crime-Management Systems Development

Identify new and emerging fraud risk factors, draft key elements of fraud prevention policies and procedures, and propose new and/or improved anti-fraud systems functionalities to enable the organization to prevent fraud/financial crime, detect and investigate suspicious activity, and mitigate the risks of losses or reputational harm.

Fraud/Financial Crime Investigation

Investigate complex cases of suspected fraud or financial crime. Identify lines of inquiry, and gather and retain information and physical or electronic evidence that enables criminal investigation and/or legal action, engaging specialist investigators or subject-matter experts where necessary. Review the evidence gathered and recommend appropriate action to the organization.

Leadership and Direction

Communicate the actions needed to implement the function's strategy and business plan within the team; explain the relationship to the broader organization's mission, vision, and values; motivate people to commit to these and to do extraordinary things to achieve local business goals.

Performance Management

Manage and report on the performance of a substantial, diverse team; set appropriate performance objectives for direct reports or project/account team members and hold individuals accountable for achieving them; take appropriate corrective action where necessary to ensure the achievement of team/personal objectives.

Budgeting

Deliver a budget for an area of the organization or conduct complex analyses on budget progress in other areas of the organization.

Solutions Analysis

Identify and evaluate complex, expertise-led solutions against a range of criteria to find the ones that best meet business needs.

Regulatory and Compliance Management

Help design and implement a compliance program, liaising with the regulator to ensure the program adheres to regulatory and compliance standards. This may also involve supervising the activities of a regulatory/compliance team.

Financial Policies, Guidelines, and Protocols

Create a plan to deliver and review financial policies, guidelines, and protocols to ensure the company complies with regulations and good financial practice.

Organizational Capability Building

Use the organization's formal development framework to identify the team's individual development needs. Plan and implement actions to build their capabilities. Provide training or coaching to others throughout the organization in own area of expertise to enable others to improve performance and fulfill personal potential.

Duties and responsibilities will include:

• Lead and manage the end-to-end claims, benefits administration, disinvestments, maturities, surrenders and withdrawals,

• Review, analyse and adjudicate complex, high-value insurance claims in line with company policy, procedures and customer service standards,

• Authorise claims within delegated authority and refer complex or unresolved matters to the line manager,
• Lead fraud and financial crime prevention activities, investigate suspected cases, gather evidence, and recommend appropriate action
• Provide leadership and direction to the claims team, translating strategy into action and motivating the team to achieve business goals
• Manage and report on team performance, setting clear objectives and taking corrective action where necessary
• Lead the administration of retirement fund benefits, Section 37C death claims, NARAF and unclaimed benefits, ensuring accurate reporting, regulatory compliance, fair beneficiary allocations, and timely payment of benefits.
• Identify and evaluate expertise-led solutions to complex claims and business challenges
• Help design and implement the department's regulatory compliance programme, liaising with the regulator as required
• Identify team development needs and provide coaching and training to build organisational capability

Minimum Requirements:

• A postgraduate qualification (NQF Level 8) in Insurance, Risk Management, Business Administration, Commerce, Finance, Accounting, Law, or a related field
• A minimum of 7 to 10 years' relevant experience in claims management within the insurance industry, of which at least 5 years must be at a managerial level
• Proven experience in claims operations, claims adjudication, customer dispute resolution, and the management of high-value and complex claims
• Sound knowledge of insurance principles, policy interpretation, claims governance, risk management, fraud prevention and regulatory compliance
• Proven leadership and people management capabilities, including performance management, coaching and team development
• Strong analytical, problem-solving, decision-making and stakeholder management skills
• Excellent communication, negotiation and relationship management skills
• Professional insurance or risk management certifications will be an added advantage

 

Skills

Accounting, Action Planning, Claims Management, Current State Assessment, Data Compilation, Data Controls, Executing Plans, Financial Auditing, Insurance Claims Investigations, Policies & Procedures, Typology

Competencies

Builds Effective Teams

Business Insight

Collaborates

Communicates Effectively

Decision Quality

Financial Acumen

Instills Trust

Manages Complexity

Education

NQF Level 8 - Honours or Postgraduate Diploma or equivalent

Closing Date

04 September 2026 , 23:59

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