Senior Claims Assessor

Let's Write Africa's Story Together!

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

Job Description

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Handles a variety of coverage with a defined loss potential. Reviews and proceses claims of high face value or liability against policies and coverage information. Decision-making is structured and objective. Initiates necessary investigations. Exercises judgment to assign adjusters or to refer information to attorneys or subject-matter experts for additional data. Settles and negotiates claims within authorised authority.

ResponsibilitiesFraud/Financial Crime Investigation

Investigate cases of suspected fraud or financial crime. Identify lines of inquiry, and gather and retain information and physical or electronic evidence to support criminal investigation and/or legal action, engaging specialist investigators or subject-matter experts where necessary. Review the evidence gathered and recommend appropriate action to the organization.

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.

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.

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.

Operations Management

Supervise others working within established operational systems.

Document Preparation

Organize and prepare complex documents using a variety of applications for technology devices, such as standard office software. Also responsible for gathering and summarizing data for special reports.

Operational Compliance

Identify, within the team, instances of noncompliance with the organization's policies and procedures and/or relevant regulatory codes and codes of conduct, reporting these instances and escalating issues as appropriate.

Personal Capability Building

Develop own capabilities by participating in assessment and development planning activities as well as formal and informal training and coaching; gain or maintain external professional accreditation, where relevant, to improve performance and fulfill personal potential. Maintain an understanding of relevant technology, external regulation, and industry best practices through ongoing education, attending conferences, and reading specialist media.

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.

Resolving Customer Issues

Respond to more advanced issue escalations promptly and appropriately; provide managerial approvals as required.

Solutions Analysis

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

Skills

Action Planning, Claims Management, Claims Settlement, Data Compilation, Data Controls, Executing Plans, Financial Auditing, Insurance Claims Investigations, Oral Communications, Presenting Solutions

Competencies

Business InsightCollaboratesDecision QualityDrives ResultsFinancial AcumenInstills TrustManages ComplexityOptimizes Work Processes

Education

Bachelors Degree (B)

Closing Date

28 April 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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