Job Advert Summary
To be part of the team that deals with various levels of complaints that have been escalated from the ombudsman office or by customers and/or brokers requesting adjudication on internal complaints as well as level 1 complaints.
Complaints are received in writing from the ombudsman office and/or customers and brokers and these complaints are required to be considered by gathering and reviewing all the necessary information to make a decision on the complaint.
Where the complaint is invalid, the case is required to be argued with the ombudsman offices or the Internal adjudication forum. Where the merits of the case are not in line with fairness and equity and ombudsman principles, the desired outcome is required to be discussed with the relevant business area.
The level 1 complaints role is to manage complaints received through our first line complaints handling process. Complaints are received from various sources that include social media, email, telephone, CEO’s office, regulatory bodies through the brokers office etc.) These complaints must be handled in line with the complaints management policy and procedure to ensure effective handling of complaints and fair treatment to customers.
Where a failure has been identified, improvement recommendations are required to be made to the relevant business area.
In addition, root cause analysis will be required to be conducted, and learnings with the relevant stakeholders will be shared for implementation to continuously improve the way we operate.
Required Knowledge and Experience
Key Responsibilities
- Minimum of 5 years exposure to complaints handling experience or claims experience
- Operational personal and commercial lines insurance experience
- Working knowledge of the NFO office and processes– an advantage
- Understand the regulatory requirements applicable to complaints management
- Keeping up to date with the changing regulatory environment
- Customer service orientated
- Good understanding of personal and commercial lines insurance products. ,
- Ability to interpret policy contracts and understand insurance processes to be able to analyse the merits of a case
- Excellent problem-solving skills
- Excellent administration skills
- Excellent verbal and written communication skills
- Excellent organizational skills and experience with managing multiple tasks.
- To receive ombudsman as well as internal adjudication cases and argue these with the various ombudsman offices as well as the internal adjudication approval forum based on Treating Customers Fairly (TCF) framework, regulations, and ombudsman principles.
- Customer Resolution, Ombudsman and internal adjudication case administration.
- Cases need to be considered on a fair and equitable basis and discussed with the business area(s).
- Liaison with Hollard Insure Business Units, administrators and partners to obtain the relevant information to consider the case from all angles.
- Liaison with the Ombudsman office.
- Presenting cases for review to the Internal adjudication approval forum.
- Draft written communications to the ombudsman offices as well as customers and brokers and clearly articulate the decisions that have been taken on cases.
- To ensure that Hollard is following best practice in terms of good governance related to the complaints process(s). Interact with the relevant business area(s) and be able to discuss and debate complex matters.
- Deal with complaints that are sent for decision review through level 1 sources (by the complaints team and via the internal dispute forum)
- Drive the overall complaints TAT in Insure in line with FSCA and internal targets through effective collaboration with internal and external stakeholders
- To make improvement recommendations where there has been a failure on the part of Hollard.
- To drive continuous improvement through root cause analysis and identification and tracking of learnings being implemented by the business.
- To contribute to business operational efficiency by ensuring consistent decision making across the relevant business area(s).
- Compile monthly reports, as well as adhoc reports, that meet regulatory reporting requirements requested by stakeholders (internal and external)
- Attend various forums and meetings (weekly claims forum, Customer Resolution dispute forum, branch forums, monthly claims forum, etc.) to provide insights from a NFO and an internal adjudication perspective in an attempt to avoid complaints and overturns on these cases. This will include the attendance of the ASK OSTI forum to provide views on matters, taking into account previous rulings made by the NFO.
- Provide assistance as required for Customer & Broker Experience ad-hoc requests and projects.
Educational Requirements
- Minimum of 5 years exposure to complaints handling experience or claims experience
- Operational personal and commercial lines insurance experienceWorking knowledge of the NFO office and processes– an advantage.
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