Insurance Operations and Claims Manager

MAIN PURPOSE OF THE JOB

Develop functional unit business plans for both the life and non-life insurance business to contribute to the achievement of strategic objectives of the organisation.

Oversee the effective functioning of claims management processes across all product lines to drive efficient client serving and customer centricity.

Key Performance Areas

• Operations Management : Processes and Systems
• Lead the development, implementation and maintenance of a suitable policy administration systems and IT applications for all product lines, both life and non-life.
• Direct and manage the implementation of policy administration and ensure proper documentation and record keeping.
• Ensure that manual processes are appropriately automated and drive innovation and continuous improvement through collaboration and agile work practices.
• Maintain data in an acceptable format and ensure that it is disseminated to relevant departments on a timely basis.
• Identify solutions to enhance cost effectiveness and increase operational efficiency.
• Develop compelling business cases to support new initiatives at improving efficiencies.
• Manage system debit order collections, premium allocation, refunds and reconciliations.
• Manage the Sasria portfolio and ensure that relevant rates are embedded in the system.
• Manage regulatory reporting e.g. Conduct of Business Returns and Liquidity Reports etc.
• Develop, maintain and optimize end to end business processes and workflows.
• Ensure effective reporting on business performance and tailor reports using the latest tools and software e.g. Power BI, Qlikview to drive business insights.
• Claims Management
• Plan, lead and coordinate the claims function, fostering an environment of continuous improvement and excellence.
• Design processes and procedures to ensure effective claims processes and strategies to adherence to service level standards.
• Develop effective automated systems for handling claims, and lead procurement efforts for the acquisition of such systems within PFMA guidelines.
• Maintain claims register for all classes of business and ensure response is provided to claimants timely.
• Monitor and conduct regular audits on claims mandates to binder holders.
• Effect cost savings and management of claim assessment costs.
• Optimise the claims reporting process, finding innovative ways to make it easier for clients to lodge claims.
• Maintain and provide accurate claims data to the actuarial department for reserving purposes.
• Identifying claims trends and alerting underwriters where loss ratios are deteriorating.
• Perform monthly analysis and reporting of claims data to identify trends, fraud and possible problem areas.
• Handle all internal and external audit queries relating to claims.
• Maintain up-to-date knowledge of industry regulations and ensure compliance in all claims handling procedures.
• Deliver exceptional customer service by effectively communicating with all stakeholders and resolving claims expediently.
• Develop appropriate systems for handling and tracking complaints.
• Manage and resolve customer queries in line with the complaints management policy.
• Lead and create an organisation-wide customer orientation and develop the infrastructure for customer relationship building to place the customer at the centre of the organisation.
• Ensuring that the objectives of TCF are consistently achieved within the team, that the achievement of such objectives can be evidenced.
• Bancassurance and Direct Channel Optimization
• Evaluate the current bancassurance and direct channel capabilities, identify gaps, and prioritise development activities.
• Optimise process and system integration relating to lead generation, quotation and policy conversions.
• Facilitate training of client facing staff on an ongoing basis to ensure a productive channel at all times.
• Monthly reporting to key stakeholders on channel performance.
• Lead and create an organisation-wide customer orientation and develop the infrastructure for customer relationship building to place the customer at the centre of the organisation.
• Lead customer satisfaction surveys and implement remedial action.
• Stakeholder management
• Design and implement a stakeholder management framework.
• Maintain relationships with stakeholders and business partners, e.g. procurement, and I.T
• Ensure that service level agreement with business partners are adhered to.
• Ensure that all work conforms to the quality requirements in terms of delivery.
• Initiate corrective actions where required to maintain quality standards.
• Ensure that all policies and procedures are maintained to enable compliance measurement.
• Develop and present a monthly stakeholder engagement report.
• Departmental and People Management
• Performance Management
• Capacity Planning
• Financial Management

Preferred Minimum Education and Experience

Critical Competencies

Additional Requirements