Job Description

Job Advert Summary

Overall Job Purpose

The Head of Claims is responsible for leading the end-to-end claims function across the PPS life insurance portfolio, ensuring a seamless, fair, and empathetic claims experience for members. This role plays a critical part in preserving the trust and integrity of the PPS brand by upholding high service standards, effective risk control, and ethical claims practices. The incumbent will drive strategic innovation in claims management, enhance operational efficiency, and build a member and intermediary first culture that aligns with PPS's mutual model.

Key Accountabilities

Strategic Leadership

Define and lead the PPS Claims strategy, ensuring alignment with the PPS vision, values, and mutuality. Collaborate with various departments including Advice & Distribution, Research & Development, Underwriting, Product Development, Operational Finance, and Member Services to enable integrated decision-making and improved member outcomes. Engage externally i.e. with re-insurers and other industry players to understand local and global trends to ensure our claims processes remain relevant, future fit and a great experience. Use data and insights to understand and improve the claims experience Be the face of claims at PPS by engaging industry peers/ bodies and building relationships with intermediaries

Claims Operations & Oversight

Design, implement, monitor and improve the operating model to deliver great claims experience balancing ease of claiming, consistency of experience, adherence to guidelines and efficiency Work with the Research and Development team to review claims policies, guidelines, and controls to ensure consistency and manage the claims experience. Manage complex, high-value, or disputed claims, ensuring decisions are well-justified and member-centric.

Member and Intermediary Experience & Service Delivery

Drive a culture of continuous improvement, empathy, simplicity and accuracy in all member and intermediary interactions. Monitor and improve key service metrics such as member and intermediary experience, SLAs, and claims decision accuracy. Champion the voice of the member and intermediary in claims process design, technology, and communication. Ensure members and intermediaries experience a professional, empathetic and accessible team. Draft regular reports for the department, as well as internal and external forms to expose operational opportunities and manage risk in claims

Risk, Governance & Compliance

Authorisation of claims in terms of delegation of authority. Ensure compliance with regulatory requirements, industry standards, and internal risk frameworks. Lead audits, reviews, and forensic investigations when necessary, ensuring sound documentation and ethical handling. Monitor trends, fraud risks, and claim patterns to proactively mitigate financial and reputational risks.

Team Development

Lead, inspire, and develop a high-performing claims team. Promote a learning and accountability culture that values collaboration, integrity, and innovation. Implement succession planning, skills development, and capability building across the claims function.

Innovation & Digital Transformation

Partner with IT, Digital, and Data teams to modernise the claims journey through automation, AI, and advanced analytics. Introduce technology solutions to streamline claims processing and improve risk assessment.

Keep pace with industry advancements, regulatory changes, and medical/legal developments that affect claims outcomes.

Minimum Requirements

Education:

University Degree Postgraduate qualification or MBA is advantageous as is a medical qualification

Experience:

Minimum of 10 years' experience in claims management within the life insurance or related sector, with at least 5 years in a senior leadership role. Proven track record of leading claims teams, improving claims experience, and managing complex cases. Process optimisation and digitisation (automation) of end-to-end processes

Knowledge and Skills (maximum of

10):

In-depth knowledge of sickness, life, critical illness, and disability claims. Strong understanding of the legal, regulatory, and risk landscape in South Africa. Excellent analytical, decision-making, and conflict resolution skills. Strong stakeholder management and people leadership capabilities. Data and process driven mindset

Competencies (maximum of 8):

Compassionate, ethical, and principled - committed to doing the right thing for members. Decisive and solutions-oriented, with sound judgment under pressure. Strategic thinker who can balance empathy with risk control.

Collaborative leader who builds trust across teams and thrives in a purpose-driven environment.

Duties and Responsibilities

Education:

University Degree Postgraduate qualification or MBA is advantageous as is a medical qualification

Experience:

Minimum of 10 years' experience in claims management within the life insurance or related sector, with at least 5 years in a senior leadership role. Proven track record of leading claims teams, improving claims experience, and managing complex cases. * Process optimisation and digitisation (automation) of end-to-end processes