Purpose of the Role

To lead claims specialists managing varied portfolios, overseeing quality, productivity, fraud control, and customer outcomes in line with governance requirements.

Overview of Role Responsibilities (Level 1-13)

Insurance Claims Administration- Level 5 - Application
Review and analyze assigned insurance claims in line with the organization's standard claims procedures and customer service standards. Engage loss adjusters and/or subject-matter experts where appropriate, authorize claims within delegated authority, and refer complex or unresolved issues to senior colleagues.

Insurance Claims Evaluation- Level 5 - Application
Interview and/or visit claimants to evaluate the extent of liability and the value of insured losses in line with policy coverage. Adjust losses and negotiate settlement within delegated authority limits, referring complex or disputed claims to senior colleagues for resolution.

Leadership and Direction- Level 5 - Application
Explain the local action plan, to support team members in their understanding of what needs to be done, and how this relates to the broader business plan and the organization's strategy, mission, and vision; motivate people to achieve local business goals.

Performance Management- Level 5 - Application
Respond to personal objectives and use performance management systems to improve personal performance; or monitor the performance of the team, allocate work and review completion, take appropriate corrective action to ensure timeliness and quality, and contribute to formal individual performance management and appraisal.

Organizational Capability Building- Level 5 - Application
Provide coaching to team members to develop their skills.

Operational Compliance- Level 5 - Application
Identify, within the team, instances of noncompliance with the organization's policies and procedures and/or relevant regulatory codes and codes of conduct, reporting these instances and escalating issues as appropriate.

Required Skills

Policy and procedures - Fully Competent
Works with full competence to monitor, interpret and understand policies and procedures and ensure their alignment with organizational strategies and work objectives. Typically works without supervision and may provide technical guidance.

Claims Management - Fully Competent
Works with full competence to handle individual and portfolios of claims cost effectively, minimizing claims leakage, and meeting organizational and customer claims service standards. Typically works without supervision and may provide technical guidance.

Claims Handling - Fully Competent
Works with full competence to use and apply processes and procedures for processing claims by an intermediary. Typically works without supervision and may provide technical guidance.

Claims Settlement - Fully Competent
Works with full competence to agree quantum and settle claims, identifying any opportunities for recoveries and its application. Typically works without supervision and may provide technical guidance.

Claims Notification and Investigation - Fully Competent
Works with full competence to use and apply the claims notification process, and validate and investigate claims. Typically works without supervision and may provide technical guidance.

Verbal Communication - Fully Competent
Works with full competence to express ideas, request actions, formulate plans, and policies by means of clear and effective verbal communications. Typically works without supervision and may provide technical guidance.

General Experience

Matric

Bachelor’s degree or Diploma in Business Administration, Management, or a related field (advantageous)

3+ years’ experience in a claims environment, with exposure to leadership or supervisory responsibilities (preferred).

Proficiency in MS Word and Excel (intermediate level essential).

Strong computer literacy and ability to adapt to new systems.

Managerial Experience

Experience of general supervision of employees (Minimum 3 year) in a claims environment

Education

Required Behavioural Competencies