Specialist: Claims Technical Advisor / Rejections (3 Months Contract)

Old Mutual; Johannesburg; On-site; ZAR 700 000 - 900 000; Full time

Job summary

A leading financial services provider in Johannesburg is seeking an experienced professional to manage insurance complaints, ensuring fair resolutions and stakeholder engagement. This role demands a solid background in complaints management within the General Insurance Industry, alongside knowledge of relevant regulatory frameworks. Candidates should possess an LLB or equivalent degree and have significant experience working with the Ombudsman, with a focus on continuous improvement, compliance, and maintaining high service delivery standards.

Qualifications

• 5 – 8 years' experience in a complaints management function in the General Insurance Industry.
• 2 – 3 years' experience working with the Ombudsman.
• Strong understanding of regulatory requirements and consumer issues.

Responsibilities

• Investigate and resolve insurance complaints efficiently and fairly.
• Acknowledge disputes and provide timely feedback on customer queries.
• Contribute to maintaining the complaints reporting and tracking system.

Skills

Complaint resolution

Stakeholder engagement

Root cause analysis

Education

LLB or equivalent degree

Job description

Job Description

Purpose of the Job

Facilitate and mediate an independent process for claim rejection disputes or claims that cannot be resolved through the organisation's 1st line complaints management process.

Critical objectives and responsibilities

• Investigate the complaint by gathering all relevant facts from the claimant and use other sources deemed necessary to ensure that decisions are fair, impartial and aligned to regulatory and/or legislative requirements.
• Resolve insurance complaints fairly, efficiently and impartially and not be swayed by business pressures.
• Acknowledge new disputes timeously.
• Conduct root cause analysis of claim rejection disputes and recommend implementation of proactive prevention measures.
• Maintain a professional relationship with the Internal Arbitrator and business stakeholders when dealing with complaints and be responsible for all communications between the business and the internal arbitrator.
• Stay well informed of the Ombudsman’s thinking on emerging consumer issues and ensure that decisions are in line with industry practices.
• Resolve escalated customer queries and complaints regarding claim rejection disputes and ensure timely feedback is provided to customers and brokers on all matters.
• Facilitate and maintain an effective TCF (Treating Customer Fairly) approach to the management of complaints.
• Contribute to the maintenance of the complaints reporting and tracking system.
• Appropriately escalated complaints to different specialist areas.
• Manage complaints end to end, prioritising according to agreed criteria even if the resolution was finalised in another department.
• Track the progression of action plans from claim rejection dispute complaints.

Service delivery to ensure customer satisfaction

• Maintain service, quality and desired outputs within the complaints process by ensuring compliance to tactical policies, procedures and standards.
• Establish productive operational relationships with key stakeholders in the various channels and administrative teams.
• Develop work routines in line with operational plans / schedules to manage achievement of service delivery goals.
• Share knowledge on, and participate in the creation of new standards, control systems and procedures to maintain service delivery.

Continuous improvement to ensure effective service

• Ensure statutory and legislative knowledge is always current in order to resolve customer complaints, advise the business on corrective solutions to mitigate risks and improve the customer experience while complying with governance requirements.
• Ensure adherence to organisational policies, practices and procedures.
• Identify solutions to enhance cost effectiveness and increase operational efficiency.

Manage quality people practices

• Align own behaviour with the organisation culture and values.
• Share and transfer process, statutory and legislative knowledge to colleagues.
• Collaborate and work with the complaints management team to deliver required service levels.
• Actively share information with other team members regarding successes, issues, trends and ideas.

Experience, knowledge & skills required

• LLB or equivalent degree.
• 5 – 8 years’ experience in a complaints management function in the General Insurance Industry.
• 2 – 3 years’ experience working with the Ombudsman.

Closing Date

23 December 2025, 23:59

The appointment will be made from the designated group in line with the Employment Equity Plan of Old Mutual South Africa and the specific business unit in question.

The Old Mutual Story!

Old Mutual is a firm believer in the African opportunity and our diverse talent reflects this.