Insurance Operations Leader: Claims & Fulfilment

Confluent; Wes-Kaap; On-site; ZAR 1,200,000 - 1,800,000; Full time

Job summary

Confluent is seeking an Operations Head: Insurance (Claims & Fulfilment) to lead claims and policy fulfilment operations at executive level. You will drive performance, ensure fair outcomes and build a capable leadership team in a regulated environment.

You will establish SLAs, oversee QA, and manage risk, with a focus on customer fairness and operational excellence. This role requires strong regulatory knowledge and proven people leadership within insurance.

Qualifications

• Experience in insurance, including both claims and policy administration.
• 5 years' people management experience, of which 3 years at middle or senior level managing team leaders or managers.
• Full Representative (not under supervision) for the FSP's licensed categories.
• Appropriate Degree will be required.
• Honesty, integrity, good standing and financial soundness; CPD up to date.
• No debarment, no record of dishonesty; clear credit and criminal checks.
• Meets Key Individual Fit and Proper requirements within 9 months; RE1 and RE5 passed; FSCA-recognized qualification applicable to the FSP's license categories.

Responsibilities

• Lead end-to-end claims performance against product SLAs, accuracy and complaint targets.
• Hold final approval for claims above M2 limits, refunds and exceptions.
• Directly manage the Claims Insurance Specialist on technical claims, escalations, audit preparation and specific projects.
• Maintain the Claims QA function, aligned with insurer QA and Group Business Assurance.
• Manage the claims relationship with insurers, including escalations and exception handling.
• Drive root cause analysis on claims defects and rework, delegated to M2 and M1 under guidance.
• Lead the Fulfilment team in delivering client service across the policy lifecycle: policy administration, changes, queries, refunds and complaints.
• Set and monitor fulfilment SLAs and cycle times, with a first time-right, fair-outcome standard for every client interaction.
• Maintain the Fulfilment QA function and ensure complaints are handled in line with TCF and Policyholder Protection Rules.
• Use complaint and query trends to fix underlying process issues, not just individual cases.
• Lead the M2 Operations Manager and the M1 Claims and Fulfilment Team Leaders and their teams.
• Drive performance management, training, skills upliftment and succession planning across both layers.
• Approve leave, overtime, performance ratings and disciplinary actions for direct and indirect reports.
• Build a high-performance, accountable culture with psychological safety; reduce avoidable absenteeism and disciplinary issues.
• Manage day-to-day operations with the M2 Operations Manager and claims assessment, validation and fulfilment processing to M1 Team Leaders, with clear oversight and feedback loops.
• Prioritize and oversee system improvement and automation projects that reduce defects and rework and improve turnaround.
• Review and approve UAT outcomes and deployment readiness for new processes and product features.
• Sign off operational policy, process and system changes.
• Act as liaison between Operations, Compliance, IT, Products and Finance.
• Deliver monthly Operations and Exco report on time, with trends and forward-looking insight.
• Manage relationships with insurers, external compliance officers and auditors.
• Contribute to budgeting, forecasting and capacity planning with Finance; keeping within approved variance.
• Recommend new roles, resourcing changes and automation initiatives within the department.

Skills

Insurance experience

People management

Regulatory compliance

Integrity & ethics

Education

Relevant degree

Job description

Confluent is seeking an Operations Head: Insurance (Claims & Fulfilment) to lead claims and policy fulfilment operations at executive level. You will drive performance, ensure fair outcomes and build a capable leadership team in a regulated environment.

You will establish SLAs, oversee QA, and manage risk, with a focus on customer fairness and operational excellence. This role requires strong regulatory knowledge and proven people leadership within insurance.