Specialist : Claims Technical Advisor / Rejections

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

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 the relevant facts from the claimant and using 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.
• 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 in respect of the claim rejection disputes and ensure that 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 escalation 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.
• Track the progression of action plans from claim rejection dispute complaints.

Service Delivery to Ensure Customer Satisfaction

Continuous Improvement to Ensure Effective Service

Manage Quality People Practices

Experience, Knowledge & Skills Required

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.

Qualified to resolve claims and negotiate settlements, while maintaining compliance with regulatory requirements.

Skills : Action Planning, Claims Management, Data Compilation, Data Controls, Executing Plans, Financial Auditing, Insurance Claims Investigations, Oral Communications, Policies & Procedures, Typology.

Competencies : Business Insight, Collaborates, Communicates Effectively, Decision Quality, Directs Work, Ensures Accountability, Financial Acumen, Instills Trust.

Education : NQF Level 7 – Degree, Advance Diploma or Postgraduate Certificate or equivalent.

Closing Date : 13 November 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.

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