Job Description

Job Advert Summary

This role is responsible for managing complaints and appeals addressed to the Internal Arbitrator and the effective running of the Office of the Internal Arbitrator. The incumbent is a senior specialist dealing with technical and complex client appeals and/or complaints. This role reports into the Head: Research and Development and Group TCF, within the Life Solutions structure.
The Office of the Internal Arbitrator receives and consider appeals or complaints from members or policyholders against final decisions made by PPS Insurance flowing from disputes between the parties. The office also responds to complaints received from the Ombudsman for Long-term Insurance that have not previously been seen by the office and attempts to resolve these directly with the complainant.
The office acts in an independent, impartial, and objective fashion and does not form part of any PPS operations. The Internal Arbitrator does not require any approval for his decisions and the Internal Arbitratorxe2x80x99s decisions are binding on the Insurer. The incumbent will, with the values of independence, integrity, and professionalism:

• Establish whether the internal remedies available to the complainant have been exhausted and if not, redirect the matter to PPS for finalisation.
• Resolve matters by way of mediation and if mediation is not appropriate, resolve the matter by determination.

Minimum Requirements

Qualification:

• Matric.
• LL B Degree or equivalent qualification.

Knowledge & Experience:

• At least 5 yearsxe2x80x99 experience as Legal Adviser in the long-term insurance industry or in dispute resolution.
• Knowledge of PPS products essential.
• Knowledge of PPS processes an advantage.

Skills and Attributes:

• Ability to act with confidence and to work independently but also part of a team.
  Ability to analyse complex investigations independently.
• A deep understanding of the life insurance industry, applicable legal frameworks, PPS policies and procedures and the PPS Provider Policy.
• Strong analytical skills with an ability to comprehend, recall, and apply facts.
• Experience in working in alternative dispute resolution.
• The ability to manage caseload in an efficient, fair and timely manner with a clear customer focus on achieving timely and fair outcomes.
• Excellent interpersonal skills to deal with people at all levels effectively.
• Excellent communication and writing skills.

Duties and Responsibilities

Case Management of Complaints:

• Effectively manage complaint or appeal cases from initiation, through investigation to finalisation.
• Work across organisational boundaries in securing appropriate stakeholders support within agreed timelines.
• Identify the issues that form the subject of the complaint or appeal and the information required to resolve the identified issues.
• Apply extensive knowledge of PPS processes to determine if PPS has dealt with the complaint efficiently and effectively.
• Apply extensive knowledge of the PPS Provider Policy to cases to ensure that complaints are resolved in accordance with applicable contractual terms.
• Apply due weight to considerations of equity to ensure that complainants are dealt with fairly.
• Apply relevant legal principles to the facts.
• Submit determinations within a reasonable time and manage complainant expectations across the complaint journey.
• Draft quality determinations where:
  • The main issues are comprehensively and clearly articulated.
  • The writing style and language used is appropriate.
  • The format and order of arguments is well organised.
• Identify systemic issues and record themes emerging from complaints and circulate summaries of these issues where complaints or appeals are found partially or wholly in favour of complainants or where compensation is awarded.

Office and People Support:

• Manage a team of five technical specialists.
• Chair weekly meetings with office staff to discuss cases and general issues of importance.
• Promote the sharing of ideas within the team to support consistency of approach.
• Manage capacity planning to effectively deliver on service objectives and published service levels.
• Develop the skills of employees by exposing them to cases, reviewing responses and providing technical guidance.
• Build and maintain team cohesion and effectiveness.
• Actively manage operational performance outputs of the deputy internal arbitrators and support staff.
• Manage joint projects with other departments e.g. development of the Pro-Flow complaints system.
• Maintain procedure documents and complaints collateral referencing the Office of the Internal Arbitrator.
• Manage budgets for the office.

Management Information and Reporting:

• Submit required reports to the Life Solutions Steerco, Exco and the Risk and Audit Committee.
• Ensure that the office records key case inputs to facilitate effective analysis of data to report on categories of complaints or appeals.
• Maintain management information required for regulatory reporting e.g. Conduct of Business Returns.

Relationship Building and Communication:

• Collaborate effectively across business areas to achieve business objectives.
• Maintain effective relationships with staff of the Office for Long-term Insurance.
• Build and maintain relationships with PPS stakeholders across subsidiaries.
• Successfully leverage established relationships within PPS, systems, and process knowledge in order to initiate, conduct and finalise independent investigations.

Risk and compliance:

• Remain updated and informed on related regulations and legislation (FAIS, POPIA, LTIA, PPR and TCF etc.).
• Manage complaints and appeals in line with applicable contractual terms and legal principles.
• Manage complaints and appeals in line with PPS internal policies and procedures.