HEAD OF CLAIMS

SUMMARY:
an individual who will be responsible to Lead and manage the end-to-end claims function to ensure efficient, compliant, and customer-centric claims handling while delivering and meeting insurer mandates, binder agreements, strategic business objectives, and regulatory requirements.

POSITION INFO:
Responsibilities: Maintain relevance of the STA Claims SOP by applying regular updates Ensure adherence to STA Claims SOP by Claims area (way of work, process adherence, JIRA usage, policy admin system usage) Ensure that the ratio of unanswered calls / total calls is less than 3% Claims complaints to be managed within budgeted ratio for financial year (e.g. 15 per 1000 claims) Oversight/management/handling of escalations from Advisers, clients and associated value chain parties  Ensure SLA Adherence - Average 95% Number of Reworks / Total number of claims - Not more than 3% - Team Average Ensure that QA function executes tasks as required and that results are leveraged to improve operational performance Ensure that Claims Manager/Team Leaders perform quality checks and drive improvement of employee quality/quality claims outcomes Manage Insurer and value chain partner relationships Ensure binder adherence Assist with Binder and other audits Develop and implement strategies that align with the company''s broader goals and contribute to increased operational performance, profitability, and customer satisfaction Maintain and report on strategic, operational and tactical plans Oversight of complaints tickets logged, classification, management of execution, ticket governance reporting (Weekly), Group PMO pack reporting (weekly) Key leadership requirements Develop and execute the claims strategy aligned to business and insurer objectives. Lead and motivate claims management teams to achieve operational and customer service targets. Drive a high-performance culture focused on service excellence and continuous improvement. Act as a member of the executive leadership team, contributing to broader business strategy. Binder & Insurer Relationship Management Manage claims performance against binder agreements and service level agreements. Build and maintain strong relationships with insurer partners. Report on claims trends, loss ratios, leakage, customer outcomes, and operational performance.  Ensure adherence to insurer mandates Governance, Risk management and Compliance Ensure compliance with: FAIS PPR (Policyholder Protection Rules) POPIA Conduct Risk principles TCF (Treating Customers Fairly) Applicable insurer mandates and binder regulations  Maintain strong claims controls and governance frameworks. Manage fraud detection, investigation, and prevention initiatives. Oversee audit findings and implement corrective actions. (This can be internal audit, risk audits or insurer binder audits) Minimum requirements: Bachelor's degree FAIS and RE compliant (RE1/RE5) KI experience and ability to be added as Key Individual of the business Proven experience in senior management role Proven track record of driving financial and operational performance within a division Experience in managing Claims environments Analytical capability and exposure to BI tools Experience in delivering automation and optimization initiatives Proven track record of interacting with Advisers/clients Excellent leadership skills Problem solving skills Deep understanding of South African insurance market, outsource/binder environment Policy administration system experience and a solid understanding of how insurance systems work Experience with workflow systems and experience within a Binder Holder or UMA will be beneficial