29 Liability Claims jobs in South Africa

RESPONSIBILITIES

Claims Practice Management

• Attend and manage all aspects related to a portfolio of specialist claims such as claims registration, case management, drafting, diary, recoveries, and settlement negotiations.
• Draft settlement agreements and other legal documents within mandate as per the Claims Governance Folder.
• Strategically manage a portfolio of claims.
• Manage loss adjusters and attorneys appointment on matters and ensure compliance with agreed service level agreements.
• Manage system processing and compliance with systems by way of payments, updating signed off reserves, proper recordal of information etc.
• Attend to Operational duties as allocated
• Compile and manage risk reports when required
• Actively manage and record claims above certain thresholds as per The Claims Governance Folder and report on matters to Claims Co and Executive where required.
• Comply with internal and external regulatory framework and internal and external processes and procedures in accordance with organisational standards.
• Draft processes and procedures that are compliant with relevant regulatory framework and applicable legislation.
• Effectively liaise and interact with Underwriters.

Analysis

• Consider, analyse and interpret insurance policy and the contractual impact thereof for the determination of coverage;
• Critically analyse the facts of the matter and their impact on the underlying policy.
• Draft opinions on the interpretation of coverage in relation to the facts and the applicable policy, present and motivate;
• Draft opinions on merits and quantum of matter with the relevant caselaw and legislation applicable;
• Apply critical thinking to ensure appropriate decisions on merits, quantum and policy response.
• Critically consider and evaluate information provided and identify information required.
• Conduct a strategic assessment of claims and make strategic decisions and recommendations on handling of claims.
• Develop and maintain an understanding of technical and legal aspects impacting on the policy's operation.
• Make representations and recommendations on improved wording and trends identification to underwriters

Individual Claims Leadership

• Be involved in continuous training and development in respect of Case Law, Policy wording, etc.
• Assist in identifying and developing SOP's and processes to ensure claims department effectiveness.
• Take initiative in creating opportunities of interaction with Brokers and Insureds.

Client Liaison (Internal and External)

• Liaise with clients to resolve queries to the satisfaction of the affected parties within the scope of authority and / or responsibility.
• Prepare for and attend meetings and consultation with brokers, insureds, legal representatives and loss adjusters.

GENERIC

• Administrative Skills
• Analysis and Judgement
• Attention to Detail
• Client Orientation
• Communication Skills including negotiation
• Follow Up
• Initiative
• Interpersonal Skills
• Organisational Awareness
• Planning and Organising
• Teamwork
• Computer Literacy

Build a successful career with us

Qualifications

• Matric
• Law Degree
• Admitted attorney
• FAIS compliance a preference

Specific

• Ability to strategise and drive a claim to finality

Experience

• Previous casualty claims handling experience

Our commitment to transformation

Santam is the market leader in the general insurance industry in Southern Africa. As a large, diversified, and expanding company, we are committed to transformation and growth. While our headquarters are in South Africa, we are rapidly extending our presence into emerging markets across Africa and Asia.

With a client base of over 1 million policyholders, Santam serves individuals, commercial enterprises, specialist business owners, and institutions—including 80 of the Top 100 companies listed on the JSE. Our commitment to Insurance, Good and Proper goes beyond just providing cover—we offer peace of mind, ensuring our clients can focus on living in the moment, not worrying about the unexpected. Because at Santam, we believe the freedom to seize every day is worth protecting.

People drive our business, and we are committed to attracting the best talent, whether for permanent roles or short-term opportunities.

Santam is committed to diversity, inclusion, and belonging. As an equal opportunity employer, we encourage applications from candidates of all backgrounds, including persons with disabilities. We are dedicated to neuro-inclusivity and fostering a workplace where everyone can thrive.

Take the next step in your career—apply now and be part of a company that's shaping the future of insurance. This is Freedom

CLAIMS SPECIALIST

The position entails managing a portfolio of brokers as well as relationships with loss adjustors and surveyors. The daily function of handling claims notifications, opening claims and managing them through to finalisation, including claims adjustments and settlements is core to this position within a UMA.

This is a fast paced environment and requires the candidate to meet deadlines and to be able to work under pressure.

Non-negotiable requirements for the position:

1 years short term claims experience

Matric with exemption

Computer literate

A technical degree would be advantages

Salary – Market Related

Email your CV to

Job Type: Full-time

Experience:

• Claims: 1 years (Required)

License/Certification:

• Matric with exemption (Preferred)
• NQF 4 Qualification
• RE5

Job Type: Full-time

Pay: From R38 000,00 per month

License/Certification:

• Drivers License (Preferred)

Work Location: In person

CAREER OPPORTUNITY
Santam SHA
has a career opportunity for a
Senior Claims Specialist
in the Claims department which will be based in Gauteng.

*KEY RESPONSIBILITIES *
The successful candidate will manage a complex portfolio of claims from notification to closure, investing the necessary level of involvement required for each claim depending on, inter alia, the nature, category, maturity, type and quantum of the claim. This includes but are not limited to:

Claims Portfolio Management

• Regularly review individual claims within the portfolio and keep reserves and records up to date as required by Santam Marine claims controls and standards.
• Identify issues and trends in the portfolio and take appropriate and/or corrective action.
• Ensure that all claims rejections are referred to Management for discussion before submission to Client.
• Demonstrating thorough and sound application of policy knowledge to claims.
• Display fair legal understanding in dealing with technical complex claims.
• Provide feedback to leadership for all internal and external (OSTI) complaints withing the agreed service level agreement.
• Escalate problem claims to management (summons/brand and or reputational damage/complaints and near miss losses)
• Follow at all times Santam Marine Claims Reserving Philosophy and Claims Standards.
• Provide input to develop and execute claims strategies considering uncertainties, key decisions, risk management, and estimated associated costs.
• Understand and implement Santam Marine's "Treating Customers Fairly" policy.
• Understand and execute the requirements set out by the Internal Osti and Client Liaison division for complaints within the ethos of Santam Groups Claims Framework.

Working with Underwriters

• Develop an understanding of marketing and underwriting strategies for your business area and contribute to business development and renewal opportunities by attending client meetings to explain the Santam Marine claims philosophy and approach to claims handling and discussing any claims issues.
• Provide input to underwriters on review of potential or existing insured's claims experience.
• Provide feedback on claims trends and developments and their potential impact on the book.
• Collaborate with the marketing, underwriting and leadership regarding grey areas on policy wordings.

Authority and Minimum Standards Observance

• Operate within your approved claims authority at all times.
• Implement minimum operating and claim standards.
• Have thorough knowledge of industry regulations and minimum standards to ensure compliance with the regulations and Santam Marine claims and underwriting control standards and protocols.

Third party Management

• Follow Santam Marine claims procedures for the selection and retention of third-party professionals and manage these relationships to the benefit of Santam Marine claims.
• Where required conduct claim file reviews or audits and resolve any issues identified.

*KEY RESPONSIBILITIES
Broker and Insured Relations *

• Work proactively to develop and manage strong relations with key brokers and insureds.
• Promote the Santam Marine brand of excellence and professionalism in client service.
• Updates and follow-ups with Brokers and Surveyors.
• When required, provide Broker with Loss Ratio Reports.
• Where required attend meetings with Relationship Managers, ensure that the Claims Manager is included.
• Claim Specialist and Claim Handler's should not attend to meetings without a team leader and/or management.

Conflict of Interest

• Adhere to Santam Marine Conflicts of Interest policy, alert the appropriate person to any potential conflicts of interest and take steps to resolve them promptly.
• Immediately advise Head of Department if any Santam Marine Claims employee seeks to exert undue influence on you or any other team member to act improperly in the management, reserving or settlement of any claim.

People Management

• Day-to-day assistance and collaboration with remainder of team in respect of review, sign off, mentoring and on the job training as and when required.
• Contribute to, encourage and ensure teamwork in order to promote a healthy and engaged workforce.
• Review adjustments of Claim Handler/s.

Client Liaison (Internal and External)

• Respond to queries and resolve to the satisfaction of the affected parties within the scope of authority and / or responsibility.
• Prepare for and attend meetings.
• Report to Team Leader and Management complex claims and issues relating to the complex/large losses.

General Administration

• Produce reports when required (Claims Summary).
• Attend to the typing of general correspondence when necessary.
• Attend to daily administrative routine tasks in accordance with organisational standards, processes and procedures. Appointment of recovery agents for third party recoveries.
• Reviewing/Assessment of survey reports
• Claim Adjustments
• Appointment of Attorneys
• Kit estimate, note updates and Kit diary follow-up's
• Review and check adjustment
• Check and sign-off claim payment
• Check and sign-off FX payments
• Verify Bridger checks
• Maintain a filing system - All documents must be uploaded onto MFiles

*QUALIFICATIONS AND EXPERIENCE *

• Matric
• Fais Compliance a preference
• Relevant Legal or Commercial degree a preference
• Minimum 7 years actual marine specialist liability claims experience including an understanding of reinsurance facultative inwards and outwards and complex matters

COMPETENCIES

• Good written and verbal communication skills.
• Computer literate
• Written and Verbal communication skills (English)
• Excellent negotiation skills
• Development of critical skills and capabilities
• Excellent accounting and reconciliation skills for claim adjustments

Additional Competencies And Skills

• Strong Attention to Detail
• Demonstrates Initiative
• Strategic thinking and planning that challenges assumptions
• A conceptual, lateral and analytical thinking balance
• Excellent communication skills and ability to lead meetings
• Strong relationship and general management skills
• Financial skills (budget management)
• Delivery/ results orientation
• Process management and improvement
• Conflict resolution
• Strong negotiation and influencing skills
• Strong Team focussed approach
• Strong Focus on Risk and TCF

About Samtam
Santam is the market leader in the general insurance industry in Southern Africa. As a large, diversified, and expanding company, we are committed to transformation and growth. While our headquarters are in South Africa, we are rapidly extending our presence into emerging markets across Africa and Asia.

With a client base of over 1 million policyholders, Santam serves individuals, commercial enterprises, specialist business owners, and institutions—including 80 of the Top 100 companies listed on the JSE. Our commitment to Insurance, Good and Proper goes beyond just providing cover—we offer peace of mind, ensuring our clients can focus on living in the moment, not worrying about the unexpected. Because at Santam, we believe the freedom to seize every day is worth protecting.

People drive our business, and we are committed to attracting the best talent, whether for permanent roles or short-term opportunities.

Santam is committed to diversity, inclusion, and belonging. As an equal opportunity employer, we encourage applications from candidates of all backgrounds, including persons with disabilities. We are dedicated to neuro-inclusivity and fostering a workplace where everyone can thrive.

Take the next step in your career—apply now and be part of a company that's shaping the future of insurance. This is Freedom

Responsibilities
Claims Leadership

• Continuously mentor and train team members in line with legal developments and new products.
• Adhere to company claims reserving philosophy and standards.
• Develop, document, and execute claims strategies, considering uncertainties, key decisions, potential outcomes, and estimated costs.
• Learn, understand and implement the "Treating Customers Fairly" doctrine.

Claims Portfolio Management

• Manage claims portfolios to optimize performance and client satisfaction.
• Regularly review individual claims and update reserves and records as required by company controls and standards.
• Apply thorough policy knowledge to claims.
• Demonstrate extensive legal expertise in handling complex liability claims.
• Address internal and external complaints, including National Financial Ombud (NFO) complaints.

Collaboration with Underwriters

• Understand marketing and underwriting strategies for the business area.
• Contribute to business development and renewal opportunities by attending client meetings, explaining claims philosophy and approach, and discussing claims issues.
• Provide input to underwriters on potential or existing insureds' claims experience.
• Offer feedback on claims trends and developments and their impact on the book.
• Suggest improvements to policy wording.

Authority and Compliance

• Operate within approved claims authority at all times.
• Implement minimum operating and claim standards.
• Maintain thorough knowledge of industry regulations and standards to ensure compliance with company claims and underwriting protocols.

Third-Party Management

• Follow company procedures for selecting and retaining third-party professionals and manage these relationships effectively.
• Conduct claim file reviews or audits and resolve identified issues.

Broker and Insured Relations

• Proactively develop and manage strong relationships with key brokers and insureds.
• Promote the company brand of excellence and professionalism in client service.

Conflict of Interest

• Adhere to the company's Conflicts of Interest policy, promptly alerting the appropriate person to any potential conflicts and taking steps to resolve them.
• Immediately advise the Head of Department if any employee seeks to exert undue influence on claim management, reserving, or settlement.

People Management

• Guide staff on claims-related and other issues.
• Support training and development to help staff reach their full potential.
• Foster teamwork to promote a healthy and engaged workforce.
• Audit claims files as required.

Client Liaison (Internal and External)

• Respond to queries and resolve issues within the scope of authority and responsibility.
• Prepare for and attend meetings.

GENERAL ADMINISTRATOR

• Produce reports as required.
• Complete daily administrative tasks in accordance with organizational standards, processes, and procedures.
• Handle general correspondence as necessary.

QUALIFICATIONS And EXPERIENCE
Qualifications

• Matric
• Law Degree
• Admitted attorney
• FAIS compliance a preference

Experience

• Previous casualty claims handling experience

Specific

• Ability to strategise and drive a claim to finality

Our commitment to transformation
Santam is the market leader in the general insurance industry in Southern Africa. As a large, diversified, and expanding company, we are committed to transformation and growth. While our headquarters are in South Africa, we are rapidly extending our presence into emerging markets across Africa and Asia.

With a client base of over 1 million policyholders, Santam serves individuals, commercial enterprises, specialist business owners, and institutions—including 80 of the Top 100 companies listed on the JSE. Our commitment to Insurance, Good and Proper goes beyond just providing cover—we offer peace of mind, ensuring our clients can focus on living in the moment, not worrying about the unexpected. Because at Santam, we believe the freedom to seize every day is worth protecting.

People drive our business, and we are committed to attracting the best talent, whether for permanent roles or short-term opportunities.

Santam is committed to diversity, inclusion, and belonging. As an equal opportunity employer, we encourage applications from candidates of all backgrounds, including persons with disabilities. We are dedicated to neuro-inclusivity and fostering a workplace where everyone can thrive.

Take the next step in your career—apply now and be part of a company that's shaping the future of insurance. This is Freedom

Closing Date

2025/10/10

Reference Number

MMH

Job Title

Senior Claims Specialist

Position Type

Permanent

Role Family

Client Services

Cluster

International

Remote Opportunity

Some of the time

Location - Country

South Africa

Location - Province

Gauteng

Location - Town / City

Centurion

Introduction

Through our client-facing brands Metropolitan and Momentum, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations.

We help people grow their savings, protect what matters to them and invest for the future. We help companies and organizations care for and reward their employees and members. Through our own network of advisers or via independent brokers and utilizing new platforms Momentum Metropolitan provides practical financial solutions for people, communities, and businesses. Visit us at

Disclaimer

As an applicant, please verify the legitimacy of this job advert on our company career page.

Role Purpose

To provide strategic oversight, deep technical claims expertise, and process innovation across Africa Life's end-to-end claims process. The role ensures consistent, integrated, and high-quality claims experiences across markets by aligning operations to product intent, underwriting, finance, and customer service. This role brings a strategic, risk-focused, and client-centred lens to a critical value chain function and establishes a clear claims philosophy and principles across Africa Life, ensuring claims practices are not only efficient but consistent, fair, and aligned to business strategy and client trust.

Requirements

• Degree in Insurance and Risk Management, Law, Business or related field (essential)
• Claims, fraud, or forensic investigation certifications (desirable)
• Training in operational risk or process improvement (desirable)
• 7–10 years of progressive experience in insurance operations, with a strong focus on claims management and strategy
• Proven track record in leading or overseeing claims functions across multiple product lines
• Experience in fraud detection, forensic reviews, and claims risk management, ideally with exposure to African market dynamics
• Direct involvement in claims integration with underwriting, finance, actuarial, and product development functions to ensure alignment across the value chain
• Background in designing or implementing group-level claims frameworks, policies, or governance standards
• Experience in analysing large claims data sets to identify trends, cost drivers, and opportunities for strategic intervention
• Exposure to cross-country operations, managing or advising on claims practices in multiple jurisdictions
• Hands-on experience with claims systems and workflow tools (e.g., administration platforms, fraud detection systems, CRM or case management systems).
• Leadership or mentoring of claims teams or assessor groups, including capability building and training
• Experience working in regulatory and compliance-heavy environments
• Demonstrated ability to influence without authority, shaping operational improvements and governance by engaging senior stakeholders across functions
• Experience applying business analysis techniques to claims contexts – requirements gathering, process mapping, and solution design
• End-to-end claims lifecycle and processing systems
• Product design, benefit rules, and underwriting principles
• Fraud detection strategies and techniques
• Life insurance regulatory frameworks in African markets
• Claims accounting, provisioning, and reconciliations
• Cross-functional integration with service, finance, and reinsurance
• Understanding of medical conditions and disability assessments, ideally with a background or exposure to clinical or allied health professions

Duties & Responsibilities

Key Outputs
PROCESS

• Develop a business unit level claims framework and governance model.
• Lead claims analytics and deep dives into fraud trends and anomalies.
• Align claims policies and processes with product, underwriting and finance.
• Design and optimise claims workflows and handovers between countries and functions.
• Define and monitor claims-related KPIs, SLAs, and operational benchmarks.
• Use claims experience insights to recommend upstream changes to product design, underwriting practices, and policy administration systems, ensuring alignment with risk appetite and reducing claim friction.
• Partner with actuarial and reinsurance to refine agreements based on emerging claims trends and risk behaviours.
• Develop and embed a group-wide claims philosophy and best practices, ensuring alignment across countries.
• Assess the impact of claims practices on policyholder behaviour, including retention and lapse rates, and recommend interventions.
• Act as the escalation point for complex or disputed claims from in-country assessors, providing guidance and final decisions where required.

CLIENT

• Shape claims experience strategy to balance customer empathy with business risk.
• Analyse complaints and claims turnaround data to identify improvements.
• Collaborate with service and product teams to improve communication and transparency in the claims process.
• Escalate issues from claims trends to distribution and sales teams, ensuring that customer disclosures, training, and scripts accurately reflect product intent and reduce disputes.
• Drive end-to-end improvements across the value chain by linking claims feedback to upstream functions, enhancing overall customer experience and trust.

FINANCE

• Identify and prevent claims leakage and inappropriate payouts.
• Support claims provisioning and reconciliations.
• Partner with finance on claims reserve adequacy and recoveries.

PEOPLE

• Enable in-country claims teams through training, standards and technical support.
• Mentor and coach in-country assessors, not only on process but also on professional judgement, claims philosophy, and client empathy.
• Share best practices and promote a culture of fairness, risk awareness and continuous improvement.
• Act as a subject matter expert to cross-functional teams.

Competencies

• Analytical and diagnostic skills
• Process design and documentation
• Stakeholder engagement and influence
• Data interpretation and storytelling
• Risk assessment and mitigation
• Financial acumen
• Medical and clinical acumen

Location: Johannesburg, GT, ZA

About the Role

We are looking for a highly motivated (re-) insurance professional to join our P&C Reinsurance team in the Johannesburg office for the role of Claims Specialist. In this role, you will be responsible for handling a reinsurance claims portfolio with focus on the Property & Casualty lines of business primarily in South Africa and the Sub-Saharan African markets.

Key responsibilities:

• Manage and oversee a Property & Casualty claims portfolio, ensuring state-of-the-art claims management under your full responsibility.
• Monitor, steer and control claims adjudication processes to create impact, generate insights and identify trends.
• Conduct claims reviews, audits and trainings.
• Actively participate in cross-functional market teams (XFT), providing valuable claim insights and expertise to support market executives, client managers, and underwriter.
• Represent Swiss Re's expertise at industry events, client engagements, and conferences, fostering relationships with key stakeholders including clients, attorneys, adjusters, and specialists.
• Contribute to our Thought Leadership activities and internal claims expert networks, leveraging insights to differentiate Swiss Re and deliver added value to clients.

About the Team

You will be part of the Western & Southern Europe, Middle East & Africa P&C Claims team together with experienced claims handlers with different professional backgrounds and nationalities. In addition, you will work closely together with our Operations, Reserving and Market Unit colleagues in different functions and locations.

About You

We are looking for a highly proactive and adaptable team member, with a collaborative approach and a strong "can-do" attitude. Are you able to cultivate and maintain relationships, with enthusiasm to work in a diverse, global environment?

To succeed in this role you need to have excellent communication, negotiation and analytical skills and bring:

• University degree or equivalent combined with a strong commercial mindset.
• More than 3-year consistent track record of (re-) insurance and claims handling, specifically within Property & Casualty lines of business.
• Demonstrated ability to leverage artificial intelligence tools and technologies to enhance claims analysis and decision-making.
• Experience in managing and optimizing claims portfolios to ensure performance and strategic alignment.
• Proven experience in knowledge sharing, thought leadership, and delivering exceptional client service.
• Fluency in English, French and/or Portuguese language skills are a plus.
• Proficiency in MS Office suite.
• The role may require some travel within the region.

We provide feedback to all candidates via email. If you have not heard back from us, please check your spam folder.

Preference will be given to Employment Equity candidates.

The base salary range for this position is between R620,000 and R1,040,000 (for a full-time role). The specific salary offered considers:

• the requirements, scope, complexity and responsibilities of the role,
• the applicant's own profile including education/qualifications, expertise, specialisation, skills and experience.

In addition to your base salary, Swiss Re offers an attractive performance-based variable compensation component, designed to recognise your achievements. Further you will enjoy a variety of global and location specific benefits.

Eligibility may vary depending on the terms of Swiss Re policies and your employment contract.

About Swiss Re

Swiss Re is one of the world's leading providers of reinsurance, insurance and other forms of insurance-based risk transfer, working to make the world more resilient. We anticipate and manage a wide variety of risks, from natural catastrophes and climate change to cybercrime. We cover both Property & Casualty and Life & Health. Combining experience with creative thinking and cutting-edge expertise, we create new opportunities and solutions for our clients. This is possible thanks to the collaboration of more than 14,000 employees across the world.

Our success depends on our ability to build an inclusive culture encouraging fresh perspectives and innovative thinking. We embrace a workplace where everyone has equal opportunities to thrive and develop professionally regardless of their age, gender, race, ethnicity, gender identity and/or expression, sexual orientation, physical or mental ability, skillset, thought or other characteristics. In our inclusive and flexible environment everyone can bring their authentic selves to work and their passion for sustainability.

If you are an experienced professional returning to the workforce after a career break, we encourage you to apply for open positions that match your skills and experience.

Keywords:

Reference Code:

Company Description

About Kaelo

Kaelo provides essential healthcare solutions ensuring the physical and psychosocial wellbeing of all South Africans towards lasting social change. Kaelo meets the Healthcare needs of Corporate and Retail clients across South Africa – products offerings include Medical Insurance, Medical Aid, Gap Insurance, Kaelo Money and employee assistance programmes.

Job Description

The Claims Specialist manages the assessment of claims and has specialised knowledge of the claims environment. There is a strong focus on accurately and efficiently resolving the claim received whilst ensuring exceptional customer service and satisfaction

Key Outcomes

• The accurate and efficient processing of claims captured
• Ad hoc duties- support in the operation of other divisions
• Contribute towards continuous improvement and innovation at process and procedure level
• To ensure that all claims processing and queries are attended to accurately and within the agreed turnaround time
• Contribute toward risk management
• Assist clients with queries and provide suitable query resolution
• Accurate completion of administrative targets on a daily basis
• Dealing with multiple telephonic queries from members, brokers and franchises
• Ongoing feedback to clients
• Ad hoc functions as required by Management

Qualifications

Qualifications

Work Experience

Required

• Insurance Industry Experience

Preferred

• Health Insurance Industry Experience

Education, Qualifications and Accreditation with Professional Body

Required

• Matric
• FAIS / RE5

Preferred

• FAIS / RE5 Accreditation with minimum 120 credits

Technical Skills or Knowledge

Required

• Computer Literate incl. Microsoft Access

Additional Information

• Accountability
• Action orientated
• Collaborative
• Communication
• Business writing skills
• Manage complexity
• Problem solving skills
• Decision thinking
• Encourages engagement
• Resilient and adaptive
• Resourceful
• Demonstrates self-awareness
• Purpose driven
• Significance and values orientated

The Collinson Group
the Collinson Group, that proudly employ over 1,100 talented individuals in over 20 locations world-wide and we are dedicated to helping our clients acquire, retain and optimize the value of their customer relationships. Some of our products and services include Priority Pass, the world's largest independent airport VIP lounge access program with 800 lounges globally and Columbus Insurance, a leading travel insurance specialist.

Role purpose:

The purpose of the role will be to deal with inbound claims calls, claims assessment, incoming e-mails, and conversational claims, providing efficient friendly customer contact with accurate relaying of information and high levels of customer service. There will also be a requirement to make outbound calls. Alongside the claims aspect, the role will be for customer support and advice for policy cover and adjustment on the easyJet product.

To provide verbal and written advice to customers on all aspects of claims handling as well as providing a high level of service to our external clients through client relationship and process efficiency. To support colleagues on a day-to-day basis.

Key Responsibilities:

• Process claims based on policy details, insurer guidelines, and industry best practices.
• Provide clear, accurate advice on policy coverage, claim decisions, and required documentation.
• Respond to customer inquiries (calls and emails) promptly, within 24 hours for emails.
• Handle inbound sales, adjustments, and service queries with a focus on service quality and conversion.
• Detect and escalate potential fraud cases, ensuring compliance with prevention measures.
• Manage claim recoveries and customer complaints, ensuring timely resolutions.
• Assist vulnerable customers with appropriate support and service.
• Meet productivity targets while maintaining quality in claims, calls, and email management.
• Ensure timely, accurate claim payments to customers and third parties.
• Adhere to FCA regulations, including Treating Customers Fairly (TCF) principles.
• Collaborate with teams to enhance workflows and customer experience.

Experience & Skills:

• Education:
  Matric or equivalent.
• Must be fluent
  in German & English
  ( both written & verbal)
• Experience:
  1+ year in insurance claims with knowledge of travel insurance products.
• Skills:
  Detail-oriented claim validation, strong communication skills (verbal and written), and numeracy for data accuracy.
• Regulatory Knowledge:
  Understanding of FCA regulations and TCF principles.
• Systems:
  Experience with Gotrex claims system is ideal or similar.
• Personal Traits:
  Motivated, proactive, organized, and professional with strong customer service and problem-solving skills.

Role Purpose

To provide strategic oversight, deep technical claims expertise, and process innovation across Africa Life's end-to-end claims process. The role ensures consistent, integrated, and high-quality claims experiences across markets by aligning operations to product intent, underwriting, finance, and customer service. This role brings a strategic, risk-focused, and client-centred lens to a critical value chain function and establishes a clear claims philosophy and principles across Africa Life, ensuring claims practices are not only efficient but consistent, fair, and aligned to business strategy and client trust.

Requirements

• Degree in Insurance and Risk Management, Law, Business or related field (essential)
• Claims, fraud, or forensic investigation certifications (desirable)
• Training in operational risk or process improvement (desirable)
• 7–10 years of progressive experience in insurance operations, with a strong focus on claims management and strategy
• Proven track record in leading or overseeing claims functions across multiple product lines
• Experience in fraud detection, forensic reviews, and claims risk management, ideally with exposure to African market dynamics
• Direct involvement in claims integration with underwriting, finance, actuarial, and product development functions to ensure alignment across the value chain
• Background in designing or implementing group-level claims frameworks, policies, or governance standards
• Experience in analysing large claims data sets to identify trends, cost drivers, and opportunities for strategic intervention
• Exposure to cross-country operations, managing or advising on claims practices in multiple jurisdictions
• Hands-on experience with claims systems and workflow tools (e.g., administration platforms, fraud detection systems, CRM or case management systems).
• Leadership or mentoring of claims teams or assessor groups, including capability building and training
• Experience working in regulatory and compliance-heavy environments
• Demonstrated ability to influence without authority, shaping operational improvements and governance by engaging senior stakeholders across functions
• Experience applying business analysis techniques to claims contexts – requirements gathering, process mapping, and solution design
• End-to-end claims lifecycle and processing systems
• Product design, benefit rules, and underwriting principles
• Fraud detection strategies and techniques
• Life insurance regulatory frameworks in African markets
• Claims accounting, provisioning, and reconciliations
• Cross-functional integration with service, finance, and reinsurance
• Understanding of medical conditions and disability assessments, ideally with a background or exposure to clinical or allied health professions

Duties and Responsibilities

Key Outputs
PROCESS

• Develop a business unit level claims framework and governance model.
• Lead claims analytics and deep dives into fraud trends and anomalies.
• Align claims policies and processes with product, underwriting and finance.
• Design and optimise claims workflows and handovers between countries and functions.
• Define and monitor claims-related KPIs, SLAs, and operational benchmarks.
• Use claims experience insights to recommend upstream changes to product design, underwriting practices, and policy administration systems, ensuring alignment with risk appetite and reducing claim friction.
• Partner with actuarial and reinsurance to refine agreements based on emerging claims trends and risk behaviours.
• Develop and embed a group-wide claims philosophy and best practices, ensuring alignment across countries.
• Assess the impact of claims practices on policyholder behaviour, including retention and lapse rates, and recommend interventions.
• Act as the escalation point for complex or disputed claims from in-country assessors, providing guidance and final decisions where required.

CLIENT

• Shape claims experience strategy to balance customer empathy with business risk.
• Analyse complaints and claims turnaround data to identify improvements.
• Collaborate with service and product teams to improve communication and transparency in the claims process.
• Escalate issues from claims trends to distribution and sales teams, ensuring that customer disclosures, training, and scripts accurately reflect product intent and reduce disputes.
• Drive end-to-end improvements across the value chain by linking claims feedback to upstream functions, enhancing overall customer experience and trust.

FINANCE

• Identify and prevent claims leakage and inappropriate payouts.
• Support claims provisioning and reconciliations.
• Partner with finance on claims reserve adequacy and recoveries.

PEOPLE

• Enable in-country claims teams through training, standards and technical support.
• Mentor and coach in-country assessors, not only on process but also on professional judgement, claims philosophy, and client empathy.
• Share best practices and promote a culture of fairness, risk awareness and continuous improvement.
• Act as a subject matter expert to cross-functional teams.

As an applicant, please verify the legitimacy of this job advert on our company career page