Operations Manager - S37C & GAP death claims

Key Responsibilities

Operations Management

• Lead end-to-end GAP death claims and Section 37C death-benefit operations, from claim notification and indexing through to validation, assessment, investigation, authorization, payment and closure.
• Establish clear ownership, segregation of duties, approval limits and escalation routes across administrators, assessors, technical specialists, team leaders and complaints support.
• Ensure consistent and compliant claims handling across all operational teams.
• Drive operational discipline across workflows, case routing, service standards, quality management and payment controls.

Work Scheduling and Allocation

• Translate forecast claim volumes, ageing, complexity, missing-document status and service commitments into medium- and long-term capacity plans.
• Allocate work across GAP and Section 37C teams based on urgency, risk, complexity, vulnerability and available capacity.
• Manage operational peaks, backlogs, absences and resource constraints to maintain service delivery.
• Monitor Section 37C investigations against the statutory 12-month tracing period and approved internal service levels.
• Prioritize vulnerable, high-risk, aged or reputationally sensitive cases.

Performance Management

• Set and manage operational scorecards covering turnaround time, aged backlog, right-first-time processing, payment accuracy, quality results, productivity, complaints, customer updates and control compliance.
• Review team and individual performance against agreed targets.
• Investigate adverse performance trends and implement corrective actions.
• Hold team leaders and operational managers accountable for sustainable performance improvement.
• Use performance insights to improve claims outcomes, service quality and operational efficiency.

Business Planning

• Develop annual and multi-year operating plans for GAP death claims and Section 37C claims operations.
• Build demand forecasts, staffing models, specialist capacity plans, service targets, control requirements, automation assumptions and cost projections.
• Prepare business cases and scenario plans that balance customer outcomes, fiduciary responsibilities, operational risk and efficiency.
• Identify future capability, technology and process requirements needed to support claims operations.

Continuous Improvement and Innovation

• Own continuous improvement across claim intake, validation, investigation, assessment, adjudication support, authorization, payment and communication.
• Translate operational challenges into clear business requirements.
• Partner with product owners, analysts, technology teams and business stakeholders to design, test and implement process or system enhancements.
• Confirm that delivered changes achieve the intended business, customer, risk and control outcomes.
• Drive automation, simplification and digitization opportunities without compromising compliance or fiduciary obligations.

Service Operations

• Manage daily service delivery across GAP and Section 37C death-claims operations.
• For GAP claims, ensure validation of scheme and member eligibility, cover, benefit amount, evidence-of-health rules where applicable, AML checks, related-claim checks and authorization or referral limits prior to payment.
• For Section 37C claims, ensure complete investigations, decision-ready records, approved allocations and accurate payment instructions.
• Monitor service levels, claim progression, outstanding information, escalations and claims awaiting decision or payment.
• Ensure claimants, beneficiaries and stakeholders receive accurate, timely and empathetic communication.

Leadership and Direction

• Translate the death-claims strategy into clear operational priorities for team leaders, assessors and support teams.
• Build a customer-focused, evidence-led and control-conscious culture.
• Lead teams through operational change, process enhancements and evolving regulatory or governance requirements.
• Reinforce ethical decision-making, accountability and service excellence.
• Create effective interfaces between GAP, Section 37C, underwriting, complaints, finance, legal, compliance, risk and technology teams.

Risk Management and Controls

• Maintain the operational risk and control framework for death claims.
• Manage risks relating to incorrect eligibility decisions, benefit calculation errors, duplicate or fraudulent claims, AML or sanctions concerns, incomplete Section 37C investigations, unauthorized allocations, incorrect payments, privacy breaches, missed service commitments and business-continuity events.
• Track incidents, root causes, control weaknesses, remediation actions and control effectiveness.
• Ensure that risk events are escalated appropriately and resolved sustainably.

Policy Development and Implementation

• Develop, interpret and maintain GAP death-claims procedures and Section 37C administration standards.
• Ensure operational standards are aligned to policy terms, fund rules, approved mandates, trustee or fund guidelines and legal requirements.
• Convert policy and legal requirements into practical workflows, checklists, templates, approval matrices and evidence standards.
• Train affected teams on new or updated requirements.
• Monitor consistent implementation across operational teams.

Operational Compliance

• Monitor adherence to Section 37C of the Pension Funds Act for retirement-fund death benefits.
• Ensure compliance with applicable GAP policy terms, fund rules, delegation mandates, financial-crime controls, data-protection requirements and internal conduct standards.
• Maintain complete audit trails and decision records.
• Ensure timely remediation of compliance, risk and audit findings.
• Drive sustainable closure of agreed management actions.

Recommendations and Governance Insights

• Use root-cause analysis, claims trends, complaint themes, audit findings and operational data to recommend changes to policies, mandates, processes, systems, staffing and controls.
• Present quantified recommendations to the appropriate governance forums.
• Track approved recommendations through implementation and benefit realization.
• Provide leadership with clear insights into operational performance, risk themes and improvement opportunities.

Internal Communication

• Maintain a structured communication plan for process changes, service performance, legal or policy updates, operational incidents, audit findings and priority actions.
• Ensure leaders and teams receive clear instructions, decision records, implementation dates and updated operating procedures.
• Manage cross-functional dependencies, escalations and stakeholder alignment.
• Communicate operational expectations in a clear, timely and consistent manner.

Budgeting and Cost Management

• Develop and manage the death-claims operating budget.
• Account for workforce requirements, specialist support, technology changes, tracing or investigation services, training and control activities.
• Monitor actual costs and benefits against plan.
• Explain variances and implement corrective actions where required.
• Deliver agreed efficiencies without compromising service quality, lawful decision-making or payment controls.

Organisational Capability Building

• Define the capability framework for GAP and Section 37C claims roles.
• Identify gaps in technical, legal, investigative, customer-service, leadership and digital capabilities.
• Implement role-based training, coaching, quality calibration, succession planning and career pathways.
• Build specialist routes for complex claims, escalations and technical referrals.
• Confirm competence through observed performance, quality outcomes and control adherence.

Section 37C Beneficiary Investigation Oversight

• Ensure each Section 37C case includes a reasonable, impartial and properly documented investigation.
• Oversee the identification and tracing of legal dependants, factual dependants and nominees.
• Ensure the nature and extent of dependency is established and supported by appropriate evidence.
• Confirm unsuccessful tracing efforts are recorded and justified.
• Ensure material conflicts, disputes or new information are addressed before a recommendation is finalized.

Section 37C Allocation and Adjudication Governance

• Ensure allocation recommendations are equitable, evidence-based and supported by clear rationale.
• Confirm that recommendations consider identified dependants, nominees, dependency circumstances and relevant fund rules.
• Keep delegated decisions within approved mandates.
• Submit complete decision packs to trustees or authorized forums where required.
• Record decisions, conditions, dissenting views and approval evidence.
• Prevent payment before all required approvals are complete.

GAP Death-Claim Validation and Assessment

• Oversee validation of claim notifications, claimant details, deceased member information, scheme approval status, membership and cover at date of event.
• Ensure policy conditions, exclusions, premium or eligibility data, benefit calculations, evidence-of-health limits where applicable, AML results, related claims and supporting documentation are reviewed.
• Route exceptions, suspected fraud and cases outside delegated authority to the correct specialist or approval level.
• Ensure GAP claims are assessed and paid only where all required validations and approvals have been completed.

Claims Quality Assurance and Payment Controls

• Operate risk-based pre-payment and post-payment quality assurance across GAP and Section 37C claims.
• Verify claimant or beneficiary identity, banking details, benefit calculations, allocation calculations, tax or deduction instructions where applicable, approval evidence, payment authorization and system records.
• Reconcile payment outcomes and address discrepancies.
• Prevent duplicate, incorrect or unauthorized payments.
• Remediate quality defects, control breakdowns and recurring processing errors.

Trustee, Fund and Client Governance

• Maintain effective relationships with trustees, claims subcommittees, fund officers, participating employers, clients and service providers.
• Provide accurate decision packs, dashboards, aged-case explanations, control attestations and management actions.
• Execute forum decisions in line with documented mandates and governance requirements.
• Ensure delegated administration remains within fund-approved authority levels.
• Support transparent, evidence-based governance across claims operations.

Complaints, Disputes and Escalations

• Ensure death-claim complaints and escalations are acknowledged, investigated and resolved within agreed standards.
• Maintain empathetic, clear and accurate communication with affected parties.
• Identify legal, reputational, conduct or systemic risks arising from complaints or disputes.
• Engage legal, compliance, trustees or senior management where required.
• Preserve the decision trail and convert complaint themes into preventive improvement actions.

Management Information and Case Reporting

• Maintain reliable dashboards and case-level reporting for claim volumes, inflows, closures, ageing, statutory milestones, internal service levels, outstanding evidence, allocations awaiting decision, authorized claims, paid claims, backlog, quality, complaints, financial exposure and productivity.
• Reconcile source data and explain exceptions.
• Use operational insights to direct resources, escalate risks and focus governance attention.
• Provide leadership and governance forums with accurate, timely and actionable reporting.

Complex-Case and Technical Referral Management

• Establish criteria and forums for technically complex, high-value, disputed, vulnerable-beneficiary, fraud-suspected or precedent-setting cases.
• Ensure timely referral to specialist assessors, underwriting, legal, compliance, forensic, tax or trustee decision-makers.
• Document technical advice, decisions and approval rationale.
• Convert precedents and lessons learned into updated guidance, training and team learning.

Beneficiary and Stakeholder Service

• Set service standards for respectful, clear and trauma-sensitive communication with claimants, dependants, nominees, employers and intermediaries.
• Ensure proactive updates on requirements, progress, delays, decisions and payments.
• Explain the different legal treatment of GAP policy claims and Section 37C benefits in a clear and accessible manner.
• Protect confidential personal information throughout the claims lifecycle.
• Promote a claims experience that is professional, empathetic and compliant.