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Job Description

This role is meant to facilitate and mediate an independent process for disputes that cannot be resolved through the organizations level 1 and 2 complaints management process.

Responsibilities will include the following:

Facilitate and mediate an independent process for disputes

• Investigate the dispute by gathering all the relevant facts from the claimant, business and use any other sources deemed necessary to ensure that decisions are fair, impartial and aligned to the regulatory and / or legislative requirements.
• Resolve insurance disputes fairly, efficiently and impartially and not swayed by business pressures.
• Acknowledge new disputes timeously.
• Conduct root cause analysis of disputes and recommend implementation of pro-active prevention measures.
• Accountable for maintaining a professional relationship with the Internal Arbitrator and business stakeholders when dealing with disputes and responsible for all communications between the business and the internal arbitrator.
• Stay well informed of the Ombudsman’s thinking on emerging consumer issues and ensure that recommendations provided to the Internal Arbitrator are in-line with industry practices.
• Resolve escalated customer queries in respect of the disputes and ensure that timeous feedback is provided to customers and brokers on all matters.
• Facilitate and maintain an effective TCF (Treating Customer Fairly) approach to the management of disputes.
• Contribute to the maintenance of the complaints reporting and complaints system.
• Appropriately escalate complaints to different specialist areas.
• Manage complaints end to end, by prioritizing according to agreed criteria even if the resolution was finalized in another department.
• Assist with tracking the progression of action plans on disputes.

 

Service delivery to ensure customer satisfaction

• Maintain service, quality and desired outputs within the dispute process by ensuring compliance to tactical policies, procedures and standards.
• Establish productive operational relationships with key stakeholders in the various channels and administrative teams.
• Develop work routines in line with operational plans / schedules to manage achievement of service delivery goals.
• Share knowledge on, and participate in the creation of new standards, control systems and procedures to maintain service delivery.

 

Continuous improvement to ensure effective service

• Ensure statutory and legislative knowledge is always current in order to resolve disputes, to advise the business on corrective solutions to mitigate risks and to improve the customer experience whilst complying with governance requirements.
• Ensure adherence to organizational policies, practices and procedures.
• Identify solutions to enhance cost effectiveness and increase operational efficiency

 

Manage quality people practices

• Align own behavior with the organization culture and values.
• Share and transfer process, statutory and legislative knowledge to colleagues.
• Collaborate and work with the complaints management team to deliver required service levels.
• Actively share information with other team members regarding successes, issues, trends and ideas.

 

Experience, Knowledge and Qualifications required:

• Diploma or Degree (preferably legal, insurance).
• RE5 completed (advantageous).
• minimum 3+ years handling Ombudsman/complaints handling  
• Excellent knowledge of the Policyholder Protection Rules (PPRs) and complaints management requirements applicable to insurers.
• Strong understanding of FAIS legislation and complaint resolution requirements.
• Strong understanding of Ombudsman rules and dispute processes.
• Excellent knowledge of Treating Customers Fairly (TCF) principles.
• Strong complaint analysis.
• Strong claims and policy-wording expertise.
• Ability to perform RCA and identify systemic risks.
• Strong Investigative ability - Reviewing claim files, correspondence, recordings, assessor reports, evidence etc.
• Strong Negotiation and influencing/stakeholder engagement skills - Engaging claims, underwriting, legal teams, brokers, and Ombudsman offices.
• Good report-writing and presentation.

The Recruitment Process:

 

• TA Interview: This will be a discussion with our Senior Talent Acquisition Specialist to give you an understanding of our business, our culture & values and more context on the role. It will also allow us the opportunity to get to know you more and ensure OMI can meet your career aspirations.
• Panel Interview: This will be with 2 members of the Senior Leadership of the Hiring Team and 1 member of the HC Senior Team.
• Technical & Psychometric Assessments: These will depend on the role and will sometimes happen concurrently with Vetting through an external service provider, as well as Internal Verification.
• Final Feedback.

 

All About OMI:

 

https://www.oldmutual.co.za/about/old-mutual-insure/ 

 

Please note that, unfortunately, we cannot accept any applications after the closing date

 

Skills

Communication, Complaint Management, Complaint Resolution, Consultative Selling, Customer Complaint Management, Customer Experience (CX), Customer Feedback Management, Customer-Focused, Customer Relationship Management (CRM) Software, Customer Service, Customer Service Operations, Customer Understanding, Data Management, Digital Consumer Engagement, Identifying Sales Opportunities, Probing Questions, Sales Data Management, Strengthening Customer Relationships, Treating Customers Fairly (TCF), Upselling

Competencies

Action Oriented

Collaborates

Communicates Effectively

Customer Focus

Decision Quality

Directs Work

Interpersonal Savvy

Manages Complexity

Education

Bachelor of Commerce (BCom): Law (Required), NQF Level 5 - Higher, Advance or Occupational Certificate or equivalent

Closing Date

02 November 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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