Claims Operations Manager - South Africa

Claims Operations Manager - South Africa

The Claims Operations Manager South Africa, will report to the EMEA Head of Claims Operations with a matrix to the South Africa Head of Claims.

This role will be responsible for claims governance & compliance, process optimization & continuous improvement, strategic execution, project delivery, claims system initiatives and where required, coordinate with TPA management, vendor management, fraud & recovery, business intelligence and Global Quality Assurance.

Key responsibilities for this role include:

Pursue continuous improvement by challenging current processes and ways of working to identify improvement opportunities whilst aligning to broader regional, international and global priorities.
Support in effectively delivering improvement initiatives and project delivery including Global GI Claims Strategic Initiatives, International projects, regional projects, local projects, and IT initiatives ensuring clear prioritization and alignment
Work collaboratively with the leadership team across South Africa Claims and Claims IT to identify and implement further opportunity for enhancements to segmentation and our digital capabilities
Develop and manage performance metrics for claims team in collaboration with South Africa Head of Claims, defining operational targets and provide continuous feedback to achieve them
Monitor claims team activity to identify trends and opportunities for improvement, including claims initiatives that will improve operational efficiencies, customer journey or indemnity and expense spend improvement
Create an operating reporting framework and report claims performance to stakeholders KPI/metric reporting in place monthly/quarterly and distributed to owners for review and analysis
Support effective claims business reporting for South Africa and region. Work with Business Intelligence Team to assist with internal reporting, ensure that accurate and timely reports/changes are maintained as required
Drive a strong control framework and lead Claims Governance & Compliance for South Africa Claims working in close collaboration with International Head of Claims Governance and Compliance
Implement strong first line controls for key risks identified in South Africa Claims, working collaboratively with Risk Officers, Internal Audit Group and Compliance, to continuously improve. Drive a strong risk management culture in South Africa Claims
Coordinate and own (where appropriate) risk event mitigation plans and resolution of internal audit action plans for South Africa Claims
Coordinate (where required) and perform governance oversight over key claims compliance requirements (Manager OFR, Duplicate Claims review, Duplicate Claims Payment review, Suspended / Pending Claims Review, Quarterly Reserve Review etc.) and controls (system - LoA reconciliation etc.) and escalate to senior management where required.
In collaboration with South Africa Head of Claims and International Head of Claims Governance and Compliance, develop and maintain South Africa Claims policies, standards, and controls ensuring Claims personnel have knowledge and receive training around AIG policies, standards, and controls
Establish and maintain appropriate means to monitor and accommodate changes in regulatory environment that impact AIGs compliance obligations
Promote various feedback mechanisms ensuring management has the necessary information needed to manage and improve performance
Coordinate and ensure timely and appropriate responses are provided to all regulatory, SOX, GQA, internal and external audits
Work with South Africa Head of Claims and leadership team across South Africa Claims to ensure that all claim employees with a reserving/settlement/payment has a Letter of Authority (LoA), system authorities are aligned to LoA and has a complete understanding of conditions contained in the LoA and the annexes
Work in close partnership with the Claims Operations functional leads - TPA Management, Vendor Management, Business Intelligence, GIS, GRS and GQA to deliver strong performance and oversight for South Africa claims
Represent South Africa Claims in committee/ meetings where appropriate
Drive a culture that promotes collaboration, diversity, equity, and inclusion
Key Qualifications
The successful candidate will have proven experience in leading successful operational teams and a demonstrated ability to communicate and influence at varying levels. The individual will also have a proven track record in governance within the Insurance industry ideally within claims. In addition, she/he will have a proven track record as an exceptionally effective change agent. The candidate will possess a strong business and process mindset and change leadership skills to unify teams around common goals and drive change.
Additional requirements include:
- Highly motivated and ability to work under own initiative and as part of a team
- Strong background in operational management and process improvement
- Expertise in Continuous Improvement Methodologies
- Strong Compliance, Governance and/or audit, regulatory background. Comprehensive awareness of the Business and Regulatory environment
- Experience in building governance frameworks within a complex organization ideal
- Strong commercial mindset with a proven track record of making sound decisions backed by data
- Ideally experienced in leading client facing teams with a service delivery mindset with knowledge of consumer and commercial claims handling.
- Exceptional communication skills including the ability to develop and present clear and concise analysis and recommendations
- Proven ability to dissect complex business issues, perform research and analysis, and synthesize conclusions into a value-maximizing strategy
- Ability to connect staff both on an individual level and in large groups; capacity to enforce accountability, cultivate entrepreneurship, and learn the strengths and weaknesses to best leverage skills and nurture talent