Head of Claims

PPS Recruitment; Johannesburg; On-site; ZAR 1 000 000 - 1 400 000; Full time

Job summary

A reputable insurance firm is seeking a Head of Claims to lead the end-to-end claims function, enhancing operational efficiency and member experience. The role involves strategic leadership, managing complex claims, and ensuring compliance with regulatory frameworks. A successful candidate will have a relevant educational background and a strong track record in claims operations, with an emphasis on innovation and team development.

Qualifications

• Experience in leading claims operations in a life insurance context.
• Proven track record of strategic leadership and team management.
• Strong understanding of regulatory requirements and industry standards.

Responsibilities

• Lead the end-to-end claims function in life insurance.
• Design and improve claims operating models for enhanced member experience.
• Manage complex and high-value claims.
• Ensure compliance with governance and risk frameworks.
• Drive innovation through technology and digital transformation.

Skills

Leadership

Risk management

Communication

Analytical skills

Empathy

Education

Relevant degree in business, insurance or related field

Job description

Overall Job Purpose

The Head of Claims is responsible for leading the end-to-end claims function across the PPS life insurance portfolio, ensuring a seamless, fair, and empathetic claims experience for members. This role plays a critical part in preserving the trust and integrity of the PPS brand by upholding high service standards, effective risk control, and ethical claims practices. The incumbent will drive strategic innovation in claims management, enhance operational efficiency, and build a member and intermediary first culture that aligns with PPS’s mutual model.

Key Accountabilities

Strategic Leadership

• Define and lead the PPS Claims strategy, ensuring alignment with the PPS vision, values, and mutuality.
• Collaborate with various departments including Advice & Distribution, Research & Development, Underwriting, Product Development, Operational Finance, and Member Services to enable integrated decision-making and improved member outcomes.
• Engage externally i.e. with re‑insurers and other industry players to understand local and global trends to ensure our claims processes remain relevant, future‑fit and a great experience.
• Use data and insights to understand and improve the claims experience.
• Be the face of claims at PPS by engaging industry peers/bodies and building relationships with intermediaries.

Claims Operations & Oversight

• Design, implement, monitor and improve the operating model to deliver great claims experience balancing ease of claiming, consistency of experience, adherence to guidelines and efficiency.
• Work with the Research and Development team to review claims policies, guidelines, and controls to ensure consistency and manage the claims experience.
• Manage complex, high‑value, or disputed claims, ensuring decisions are well‑justified and member‑centric.

Member and Intermediary Experience & Service Delivery

• Drive a culture of continuous improvement, empathy, simplicity and accuracy in all member and intermediary interactions.
• Monitor and improve key service metrics such as member and intermediary experience, SLAs, and claims decision accuracy.
• Champion the voice of the member and intermediary in claims process design, technology, and communication.
• Ensure members and intermediaries experience a professional, empathetic and accessible team.
• Draft regular reports for the department, as well as internal and external forms to expose operational opportunities and manage risk in claims.

Risk, Governance & Compliance

• Authorisation of claims in terms of delegation of authority.
• Ensure compliance with regulatory requirements, industry standards, and internal risk frameworks.
• Lead audits, reviews, and forensic investigations when necessary, ensuring sound documentation and ethical handling.
• Monitor trends, fraud risks, and claim patterns to proactively mitigate financial and reputational risks.

Team Development

• Lead, inspire, and develop a high‑performing claims team.
• Promote a learning and accountability culture that values collaboration, integrity, and innovation.
• Implement succession planning, skills development, and capability building across the claims function.

Innovation & Digital Transformation

• Partner with IT, Digital, and Data teams to modernise the claims journey through automation, AI, and advanced analytics.
• Introduce technology solutions to streamline claims processing and improve risk assessment.

Keep pace with industry advancements, regulatory changes, and medical/legal developments that affect claims outcomes.