Claims Operations Lead — Strategy, Risk & Transformation

In Place Recruitment (Pty) Ltd.; Gauteng; On-site; ZAR 837,000 - 949,000; Full time

Benefits offered by this job

Occasional travel to Potchefstroom

Job summary

In Place Recruitment (Pty) Ltd. seeks an experienced Head of Claims Operations for a leading Health Insurance provider in Gauteng.

The role emphasizes strategic leadership of the claims function, governance and operational oversight to ensure accurate and timely settlements. You will drive process improvements, KPI governance, and partnerships across Technology, Risk, Compliance, Finance and Customer Experience.

Qualifications

• Bachelor’s degree in Business Management, Insurance, Finance, Operations Management, Risk Management, or related field.
• 10+ years’ experience within Health Insurance or Medical Scheme Claims.
• 5+ years in a senior management or executive leadership role with large-scale operational teams.
• Proven ability to lead operational transformation, drive efficiency gains and manage complex change environments.
• Postgraduate degree and relevant certifications are advantageous.
• ACII or equivalent insurance qualification, Lean Six Sigma or BPM certifications advantageous.

Responsibilities

• Formulate and execute a cutting-edge Claims Operations strategy aligned with overall business objectives.
• Oversee the end-to-end claims lifecycle, ensuring alignment with service levels, quality standards and cost targets.
• Establish, monitor, and report on operational KPIs, SLAs, and performance metrics.
• Lead resource allocation, workforce optimisation, and capacity planning to match operational demands.
• Identify process bottlenecks and implement Lean practices to boost productivity.
• Partner with IT, Systems, and Risk teams to deploy technology enhancements and operating-model upgrades.
• Guarantee claims are assessed and settled accurately and in compliance with underwriting rules.
• Identify operational risks and embed robust internal controls and escalation governance.
• Monitor claims data and complaint trends to deploy corrective actions quickly.
• Recruit, mentor, and retain a high-performing, customer-centric claims team.
• Build strong partnerships with senior leaders across Technology, Risk, Compliance, Finance and Customer Experience.

Skills

Strategic leadership

Claims operations

Risk management

Stakeholder management

Change management

Quality governance

Education

Bachelor’s degree in Business Management, Insurance, Finance, Operations Management, Risk Management, or related field

Postgraduate degree in Business Management, Operations, or Risk (advantageous)

ACII or equivalent insurance qualification, Lean Six Sigma, or BPM certifications (advantageous)

Job description

In Place Recruitment (Pty) Ltd. seeks an experienced Head of Claims Operations for a leading Health Insurance provider in Gauteng.

The role emphasizes strategic leadership of the claims function, governance and operational oversight to ensure accurate and timely settlements. You will drive process improvements, KPI governance, and partnerships across Technology, Risk, Compliance, Finance and Customer Experience.