Specialist: Claims Technical Advisor​/Rejections

Let's Write Africa's Story Together! Old Mutual is a firm believer in the African opportunity and our diverse talent reflects this.

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.

• Investigate the complaint by gathering all the relevant facts from the claimant and use any other sources deemed necessary to ensure that decisions are fair, impartial and aligned to the regulatory and / or legislative requirements.
• Resolve insurance complaints fairly, efficiently and impartially and not swayed by business pressures.
• Acknowledge new disputes timeously.
• Conduct root cause analysis of claim rejection disputes and recommend implementation of pro‐active prevention measures.
• Accountable for maintaining a professional relationship with the Internal Arbitrator and business stakeholders when dealing with complaints and 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 industryерк practices.
• Resolve escalated customer queries and complaints in respect of the claim rejection disputes and ensure that timeous 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, by prioritising according to agreed criteria even if the resolution was finalized in another department.

• 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 in order 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.

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

• 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.

• 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.

Ensures that general insurance claims are handled expeditiously and in a professional manner thereby meeting the customer expectations. Manages the claims function with a team of claims assessors and negotiators. Develops the claims policy, procedures, and practices. Evaluates risks with claims, coverage complexity, and those in excess of field approval limits. Provides counsel regarding claims evaluation and coverage.

Investigate the circumstances of complex, high-value claims and the nature and extent of clients' losses. Review and evaluate information gathered using own expertise, and examine additional evidence provided by specialist investigators or subject‑matter experts…