Claims Manager

Pro Select Consulting; Durban; On-site; ZAR 900,000 - 1,350,000; Full time

Job summary

Pro Select Consulting in Durban seeks an experienced Claims Manager to lead the life insurance claims function, balancing customer outcomes with risk management and profitability. You will drive the claims philosophy, oversee complex claims, and ensure timely decisions in line with Treating Customers Fairly principles.

You will manage a high-performing team, collaborate with underwriting, regulatory, and product teams, and push process improvements and automation while maintaining strong

Qualifications

• Senior management experience in life insurance claims.
• Experience assessing and managing life insurance claims.
• Strong understanding of Treating Customers Fairly principles.

Responsibilities

• Lead, manage and develop the Operational Claims Team to handle claims volumes.
• Ensure service levels and performance targets are met consistently.
• Oversee assessment and management of life insurance claims per guidelines and reinsurer requirements.
• Identify and manage claims-related risks throughout the process.
• Ensure fair, objective, and timely claims decisions with empathy and integrity.
• Handle complex/escalated claims with legal or reinsurer involvement when needed.
• Review open claims for progress, accuracy, and guideline adherence.
• Ensure timely claim payments to support finance processing timelines.
• Communicate clearly with advisers, policyholders and stakeholders regarding outcomes.
• Provide input to product development and claims philosophy initiatives.
• Drive process improvements and automation with internal teams.

Skills

Leadership

People management

Stakeholder communication

Claims leadership

Education

Medically Trained Qualification

Job description

We are seeking an experienced and commercially minded Claims Manager to lead and manage the operational claims function. The successful candidate will be responsible for ensuring the efficient, fair and timeous assessment and management of life insurance claims, while balancing excellent customer outcomes with sound risk management and profitability.

This role requires a strong understanding of life insurance claims, underwriting, risk management, regulatory requirements and Treating Customers Fairly principles, together with the ability to lead a high-performing team and contribute strategically to claims philosophy, product development and process innovation.

Key Responsibilities:

• Lead, manage and develop the Operational Claims Team, ensuring appropriate capacity, capability, support and training to effectively manage claims volumes.
• Ensure the Claims Team consistently meets agreed service level agreements and operational performance requirements.
• Oversee the assessment and management of life insurance claims in accordance with the company's claims philosophy, internal guidelines and reinsurer requirements.
• Ensure claims-related risks are appropriately identified, assessed and managed throughout the claims process.
• Ensure claims are assessed fairly, objectively and timeously, while maintaining a strong focus on Treating Customers Fairly principles.
• Manage complex and escalated claims, referring matters to the Claims Committee, Legal team or reinsurers where required.
• Regularly review and manage open claims to ensure appropriate progress, accurate assessment and adherence to established claims guidelines.
• Ensure claims payments are authorised accurately and timeously to enable Finance to process payments within agreed turnaround times.
• Maintain clear, professional and empathetic communication with advisers, policyholders and internal stakeholders regarding claims decisions and outcomes.
• Support the Policy Servicing function with the effective investigation and resolution of claims-related complaints.
• Ensure objective retrospective underwriting is conducted as part of the claims assessment process, ensuring fairness, consistency and appropriate risk management.
• Drive a customer-centric claims experience, ensuring the team delivers service with empathy, excellence and courage in line with the company brand values.
• Identify opportunities to improve and streamline claims processes, working with internal stakeholders and the technology team to support automation and operational efficiencies.
• Take ownership of the organisation's claims philosophy, ensuring alignment with the company's risk appetite, reinsurer standards, profitability objectives and regulatory requirements.
• Develop, review and maintain claims requirements, practice notes, processes and product rules in collaboration with relevant internal and external stakeholders.
• Stay abreast of developments in local and international claims practices, medical innovation, legislation and market trends, identifying opportunities for innovation and continuous improvement.
• Provide specialist claims input into product development, ensuring that risk is appropriately considered in product design, claims rules and new product initiatives.
• Monitor, analyse and report on claims trends, emerging risks and potential red flags, providing meaningful insights to management and relevant governance structures.
• Prepare and contribute to claims reporting for management, Board, Audit and Risk Committee, regulatory and other governance purposes, including claims experience and reserve-related analysis.
• Build and maintain a strong market and stakeholder profile for the Claims function, supporting the management of reputational risks, complaints and public relations matters while ensuring consistently high levels of service to policyholders and advisers.

Personal Attributes:

• Medically Trained Qualification
• 5+ years' experience working in life insurance claims assessment
• Senior Management Experience