Team Leader: Claims (S37C)

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

Job Description

Responsible for ensuring S37C claims are processed quickly and professionally to meet customer expectations. The role oversees a team of claims assessors and negotiators, manages the claims function, and develops related policies and procedures. It also involves assessing complex or high-risk claims, especially those beyond standard approval limits, and providing expert guidance on claims evaluation and coverage decisions.

Key Result Areas:

Fraud/Financial Crime Management

• Deliver fraud prevention reporting and analysis for a designated area of operations, using financial crime/fraud prevention systems to identify instances, patterns, and trends of suspicious activity, to enable the prevention of fraud and enable the initiation of loss mitigations and fraud investigations.

Work Scheduling and Allocation

• Assign short-term work schedules to a team of subordinates in order to achieve expectations while following established timelines.

Insurance Claims Administration

• Review and analyze complex insurance claims in line with the organization's standard claims procedures and customer service standards. Initiate investigations and engage independent loss adjusters and/or subject-matter experts where appropriate. Authorize claims within delegated authority and refer unresolved issues or disputes to line manager.

Fraud/Financial Crime Investigation

• Contribute to the investigation of cases of suspected fraud or financial crime by gathering, analyzing, and retaining information and physical evidence to support criminal investigation and/or legal action. Recommend further actions to the lead investigator.

Leadership and Direction

• Explain the local action plan, to support team members in their understanding of what needs to be done, and how this relates to the broader business plan and the organization's strategy, mission, and vision; motivate people to achieve local business goals.

Fraud/Financial Crime-Management Systems Development

• Review external research and analysis, and analyze customer or client transactions to identify fraud trends and emerging risks, and to support the development of fraud/financial crime prevention strategies, policies, procedures, and monitoring systems.

Insurance Claims Evaluation

• Investigate the circumstances of claims and the nature and extent of clients' losses. Review and evaluate information gathered using own subject-matter expertise, and examine additional evidence provided by specialist investigators or subject-matter experts to determine the extent of liability. Negotiate settlement of insured losses in line with delegated authority.

Organizational Capability Building

• Provide coaching to team members to develop their skills.

Regulatory and Compliance Management

• Investigate standard incidents using current regulatory and compliance processes, systems, and procedures, and take action to solve immediate compliance issues. Advise more senior colleagues on more complex problems.

Financial Policies, Guidelines, and Protocols

• Contribute to the development and delivery of financial policies, guidelines, and protocols to ensure the company complies with regulations and good financial practice.

Performance Management

• Respond to personal objectives and use performance management systems to improve personal performance; or monitor the performance of the team, allocate work and review completion, take appropriate corrective action to ensure timeliness and quality, and contribute to formal individual performance management and appraisal.

Solutions Analysis

• Interpret data and identify possible answers. Involves navigating a wide variety of processes, procedures, and precedents.

Skills

Claims Administration, Fraud Prevention, People Leadership, Regulatory Compliance, Regulatory Compliance Management, Solution Analysis, Stakeholder Management

Competencies

Decision Quality

Directs Work

Ensures Accountability

Manages Complexity

Optimizes Work Processes

Plans and Aligns

Tech Savvy

Education

NQF Level 6 - Diploma, Advance or Occupational Certificate or equivalent

Closing Date

24 May 2026 , 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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