Head of Claims | Centurion | Permanent

PSG Konsult Ltd.; Centurion; On-site; ZAR 1,400,000 - 2,200,000; Full time

Job summary

PSG Konsult Ltd. in Centurion invites applications for Head of Claims to lead the end-to-end claims function, ensuring compliant, customer-centric handling while meeting insurer mandates, binder agreements and regulatory requirements.

The role demands strategic leadership, KPI-driven performance, and strong governance across binder relationships, SLA adherence and risk controls within the SA insurance market. Experience in claims environments and QA oversight is essential.

Qualifications

• FAIS and RE compliant (RE1/RE5).
• KI experience and ability to be added as Key Individual of the business.
• Proven track record of driving financial and operational performance within a division.
• Experience in managing Claims environments.
• Analytical capability and exposure to BI tools.
• Experience in delivering automation and optimization initiatives.
• Proven track record of interacting with Advisers/clients.
• Excellent leadership skills.
• Deep understanding of South African insurance market, outsource/binder environment.

Responsibilities

• Lead and manage the end-to-end claims function to ensure compliant, customer-centric claims handling.
• Maintain binder and insurer relationships and report on performance.
• Ensure SLA adherence and control rework/defect rates.
• Oversee governance, risk management and compliance with FAIS, POPIA, PPR.
• Drive strategic initiatives to improve operational performance and profitability.
• Oversee audits and corrective actions; manage escalations from Advisers/clients.

Skills

FAIS/RE compliance

Leadership

Claims management

Data analytics

BI tools

Automation

Stakeholder engagement

Tools

Policy administration system

Workflow systems

Job description

VACANCY | HEAD OF CLAIMS | CENTURION | PERMANENT

PSGs commitmentto transform and embrace diversity is what drives us to achieve a diverseworkplace with employment equity as a key goal to create an inclusive workforce.In achieving our employment equity goals, we give preference to applicants fromdesignated groups, and we encourage people with disability to apply.

PSG has a greatopportunity for an individual who will be responsible to Lead and manage theend-to-end claims function to ensure efficient, compliant, and customer-centricclaims handling while delivering and meeting insurer mandates, binderagreements, strategic business objectives, and regulatory requirements.

Responsibilities:

• Maintain relevance of theSTA Claims SOP by applying regular updates
• Ensure adherence to STAClaims SOP by Claims area (way of work, process adherence, JIRA usage,policy admin system usage)
• Ensure that the ratio ofunanswered calls / total calls is less than 3%
• Claims complaints to bemanaged within budgeted ratio for financial year (e.g. 15 per 1000 claims)
• Oversight/management/handlingof escalations from Advisers, clients and associated value chain parties
• Ensure SLA Adherence -Average 95%
• Number of Reworks / Totalnumber of claims - Not more than 3% - Team Average
• Ensure that QA functionexecutes tasks as required and that results are leveraged to improveoperational performance
• Ensure that ClaimsManager/Team Leaders perform quality checks and drive improvement ofemployee quality/quality claims outcomes
• Manage Insurer and valuechain partner relationships
• Ensure binder adherence
• Assist with Binder andother audits
• Develop and implementstrategies that align with the company's broader goals and contribute toincreased operational performance, profitability, and customersatisfaction
• Maintain and report onstrategic, operational and tactical plans
• Oversight of complaintstickets logged, classification, management of execution, ticket governancereporting (Weekly), Group PMO pack reporting (weekly)

Key leadership requirements

• Develop and execute theclaims strategy aligned to business and insurer objectives.
• Lead and motivate claimsmanagement teams to achieve operational and customer service targets.
• Drive a high-performanceculture focused on service excellence and continuous improvement.
• Act as a member of theexecutive leadership team, contributing to broader business strategy.

Binder & InsurerRelationship Management

• Manage claims performanceagainst binder agreements and service level agreements.
• Build and maintain strongrelationships with insurer partners.
• Report on claims trends,loss ratios, leakage, customer outcomes, and operational performance.
• Ensure adherence toinsurer mandates

Governance, Risk Managementand Compliance

• Ensure compliance with:
• FAIS
• PPR (PolicyholderProtection Rules)
• POPIA
• Applicable insurermandates and binder regulations
• Maintain strong claimscontrols and governance frameworks.
• Manage fraud detection,investigation, and prevention initiatives.
• Oversee audit findings andimplement corrective actions. (This can be internal audit, risk audits orinsurer binder audits)

Minimumrequirements:

• FAIS and RE compliant(RE1/RE5)
• KI experience and abilityto be added as Key Individual of the business
• Proven track record ofdriving financial and operational performance within a division
• Experience in managingClaims environments
• Analytical capability andexposure to BI tools
• Experience in deliveringautomation and optimization initiatives
• Proven track record ofinteracting with Advisers/clients
• Excellent leadershipskills
• Deep understanding ofSouth African insurance market, outsource/binder environment
• Policy administrationsystem experience and a solid understanding of how insurance systems work
• Experience with workflowsystems and experience within a Binder Holder or UMA will be beneficial
• Calm under pressure
• Structured/process driven
• Able to execute and followinstructions
• Eager to learn, improveand optimize
• Strategic &Decision-making mindset
• Customer-centric mindset
• High Integrity
• Accountability andownership
• Strong problem-solvingability