Insurance Operations Manager

Confluent

Cape Town, Western Cape

Full-time

Posted 2 hours ago

Full-time

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Job Description

Insurance Operations Manager

We are looking for an Operations Head to lead our Insurance Claims and Fulfilment functions and the people who deliver them. Reporting at executive level and appointed as a Key Individual of the FSP, you will be accountable for claims outcomes, policy client service and the first-line control environment.

In this role you will turn business objectives into clear operational priorities. You will make sure claims and policy fulfilment are fair, accurate and timely, and you will build a capable, accountable team across the senior and junior management layers. This role suits a strong, proven people leader who brings operational discipline and a real commitment to treating customers fairly. Insurance experience is advantageous but not essential. We will support the successful candidate in meeting the regulatory requirements of the role.

Key responsibilities

Claims management

Lead end-to-end claims performance against product SLAs, accuracy and complaint targets.
Hold final approval for claims above M2 limits, refunds and exceptions.
Directly manage the Claims Insurance Specialist on technical claims, escalations, audit preparation and specific projects.
Maintain the Claims QA function, aligned with insurer QA and Group Business Assurance.
Manage the claims relationship with insurers, including escalations and exception handling.
Drive root cause analysis on claims defects and rework, delegated to M2 and M1 under guidance.

Fulfilment and policy client service

Lead the Fulfilment team in delivering client service across the policy lifecycle: policy administration, changes, queries, refunds and complaints.
Set and monitor fulfilment SLAs and cycle times, with a first-time-right, fair-outcome standard for every client interaction.
Maintain the Fulfilment QA function and ensure complaints are handled in line with TCF and Policyholder Protection Rules.
Use complaint and query trends to fix underlying process issues, not just individual cases.

People leadership

Lead the M2 Operations Manager and the M1 Claims and Fulfilment Team Leaders and their teams.
Drive performance management, training, skills upliftment and succession planning across both layers.
Approve leave, overtime, performance ratings and disciplinary actions for direct and indirect reports.
Build a high-performance, accountable culture with psychological safety; reduce avoidable absenteeism and disciplinary issues.
Manage day-to-day operations with the M2 Operations Manager, and delegate claims assessment, validation and fulfilment processing to M1 Team Leaders, with clear oversight and feedback loops.

Systems and process optimisation

Prioritise and oversee system improvement and automation projects that reduce defects and rework and improve turnaround.
Review and approve UAT outcomes and deployment readiness for new processes and product features.
Sign off operational policy, process and system changes.

Stakeholders, budget and resourcing

Act as liaison between Operations, Compliance, IT, Products and Finance.
Deliver the monthly Operations and Exco report on time, with trends and forward-looking insight.
Manage relationships with insurers, external compliance officers and auditors.
Contribute to budgeting, forecasting and capacity planning with Finance, keeping within approved variance.
Recommend new roles, resourcing changes and automation initiatives within the department.

Requirements

5 years’ people management experience, of which 3 years at middle or senior level managing team leaders or managers
Proven track record of leading and developing multi-layer teams, including performance management, disciplinary processes and succession planning
Demonstrated experience running an operational environment against SLAs, quality and turnaround targets
Appropriate degree
Honesty, integrity, good standing and financial soundness
No debarment and no record of dishonesty; clear credit and criminal checks

Advantageous (preferred, not required)

Experience in an insurance or financial services environment, ideally in claims, policy administration or fulfilment
Full Representative status (not under supervision) for the FSP’s licensed categories, with CPD up to date
RE1 and RE5 passed
FSCA-recognised qualification applicable to the FSP’s licence categories
Working knowledge of the FAIS Act, Insurance Act, Policyholder Protection Rules and TCF

Requirements to be met after appointment

The following must be obtained within the first 9 months of the role:

Key Individual Fit and Proper requirements, including RE1
RE1 and RE5 passed
FSCA-recognised qualification applicable to the FSP’s licence categories

Regulatory knowledge

Good working knowledge of the following within 6 months of appointment:

FAIS Act 37 of 2002, General Code of Conduct and Fit and Proper Requirements (BN 194 of 2017)
Financial Sector Regulation Act 9 of 2017 and FSCA Conduct Standards
Insurance Act 18 of 2017, the Long-term and Short-term Insurance Acts and the Policyholder Protection Rules
National Credit Act 34 of 2005, including the Credit Life Insurance Regulations
FICA 38 of 2001 and RMCP requirements, including PEP and TFS screening
POPIA 4 of 2013
TCF outcomes and complaints management requirements
Awareness of the proposed COFI framework

Management competencies (required)

Leading and developing multi-layer teams, including performance management and succession
Operational management against SLAs, quality and turnaround targets
Risk and control awareness, audit response and reporting
Data-driven Exco reporting with trends and forward-looking insight
Process optimisation, system change prioritisation and UAT oversight
Budgeting, forecasting and capacity planning
Stakeholder management across business, technical and external partners

Technical competencies (advantageous)

Claims assessment and adjudication, including escalations, exceptions and insurer engagement
Policy administration, fulfilment processes, client service SLAs and quality assurance
Representative supervision, competence and debarment processes

Behavioural attributes