Insurance Senior Manager - Claims & Fulfilment

Confluent; Cape Town; Presencial; ZAR 1 200 000 - 1 800 000; Tempo integral

Resumo da oferta

Confluent in Cape Town, South Africa, seeks an Operations Head: Insurance (Claims & Fulfilment) to lead claims outcomes, client service and the first-line control environment at executive level. You will shape priorities and build a capable, accountable team across senior and junior management.

The role requires regulatory rigour, customer fairness and strong leadership to drive performance and QA, with collaboration across insurers, Compliance and IT.

Qualificações

• Experience in insurance claims and policy administration.
• 5 years of people management experience, including senior teams.
• Full Representative for FSP license categories.
• Relevant degree; CPD up to date; no debarment or criminal issues.

Responsabilidades

• Lead end-to-end claims performance against SLAs, accuracy and targets.
• Lead Fulfilment and policy client service across the lifecycle; manage QA and TCF alignment.
• Oversee system improvements, UAT, and deployment readiness for new processes and features.
• Liaise with Operations, Compliance, IT, Products and Finance; deliver Executive reporting and budgeting.

Conhecimentos

People leadership

Regulatory knowledge

Claims management

Policy administration

Data reporting

Budgeting

Forecasting

Formação académica

Bachelor's degree

Descrição da oferta de emprego

We are looking for an Operations Head: Insurance (Claims & Fulfilment) functions and the people who deliver them. Reporting at executive level and appointed as a Key Individual of the FSP, you will be accountable for claims outcomes, policy client service and the first-line control environment.

In this role you will turn business objectives into clear operational priorities. You will make sure claims and policy fulfilment are fair, accurate and timely, and you will build a capable, accountable team across the senior and junior management layers. This role suits a leader who can combine operational discipline and regulatory rigour with a real commitment to treating customers fairly.

Key responsibilities

Claims management

• 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.

Fulfilment and policy client service

• 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.

People leadership

• 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.

Systems and process optimization

• 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.

Stakeholders, budget and resourcing

• 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.

Preferred requirements

• 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

The following requirements should be obtained within the first 9 months of the role:

• Meets Key Individual Fit and Proper requirements, including RE1
• RE1 and RE5 passed
• FSCA-recognized qualification applicable to the FSP's license categories

Regulatory knowledge

Good working knowledge of the following within 6 months of appointment:

• FAIS Act 37 of 2002, General Code of Conduct and Fit and Proper Requirements (BN 194 of 2017)
• Financial Sector Regulation Act 9 of 2017 and FSCA Conduct Standards
• Insurance Act 18 of 2017, the Long-term and Short-term Insurance Acts and the Policyholder Protection Rules
• National Credit Act 34 of 2005, including the Credit Life Insurance Regulations
• FICA 38 of 2001 and RMCP requirements, including PEP and TFS screening
• POPIA 4 of 2013
• TCF outcomes and complaints management requirements
• Awareness of the proposed COFI framework

Technical and management competencies

• Claims assessment and adjudication, including escalations, exceptions and insurer engagement
• Policy administration, fulfilment processes, client service SLAs and quality assurance
• Leading and developing multi-layer teams, including performance management and succession
• Representative supervision, competence and debarment processes
• Risk and control design, audit response and regulatory reporting
• Data-driven Exco reporting with trends and forward-looking insight
• Process optimisation, system change prioritisation and UAT oversight
• Budgeting, forecasting and capacity planning

Behavioural attributes

• Leads by example with integrity and professionalism
• Customer-centric, applying fair-outcome and first-time-right principles
• Builds psychological safety and accountability in teams
• Composed under pressure in a complex operational environment
• Clear, concise communicator at executive level