| Detail | For this role |
|---|---|
| Department | Insurance |
| Level | Senior management |
| Reports to | Chief Operating Officer |
| Direct reports | Claims Manager, Claims Investigator, Motor Claims Surveyor |
| Experience | 15+ years in insurance claims with leadership |
Head of Claims job description template
Copy this job description, replace the text in square brackets and post it on your careers page or a job portal.
Job title: Head of Claims
Department: Insurance
Reports to: Chief Operating Officer
Location: [City], [office, branch or site]
About the role
A Head of Claims leads the claims function of an insurer, balancing fair, fast settlement for genuine claims against firm control of fraud and leakage. They set claims policy, lead the claims managers and investigators, and answer for the settlement ratio and turnaround. The role reports to the Chief Operating Officer or Chief Executive Officer. A good head of claims settles honest claims quickly, keeps repudiation fair and within norms, controls fraud and leakage, keeps customers satisfied at their hardest moment, and protects the insurer from paying what it should not.
Key responsibilities
- Set claims policy, authority limits and service standards across all claim types.
- Drive fast, fair settlement of genuine claims within the promised turnaround.
- Control fraud and claim leakage through investigation, checks and analytics.
- Keep repudiation fair, well reasoned and within regulatory and internal norms.
- Lead and develop the claims managers, investigators and surveyors across the function.
- Monitor the claim settlement ratio and turnaround and act on the gaps.
- Handle escalated, large and disputed claims with sound judgement.
- Coordinate with reinsurers on large individual claims and catastrophe events during the year.
- Keep claims practices compliant with regulation and grievance norms.
- Report claims performance, trends and fraud savings to leadership.
Requirements
- Graduate in any stream, insurance qualification an advantage
- Deep knowledge of claims and policy terms
- Fellowship of the Insurance Institute is an advantage
- 15+ years in insurance claims with leadership
KRAs and KPIs for a Head of Claims
Key result areas for the appraisal form, each with a KPI you can measure every month or quarter.
| Key result area | How to measure it |
|---|---|
| Settlement ratio | Claim settlement ratio held above the agreed benchmark |
| Turnaround | Claims settled within the promised turnaround above the agreed level |
| Leakage control | Claim leakage and fraud losses reduced against target |
| Repudiation fairness | Repudiations upheld on review and within norms above the agreed level |
| Customer satisfaction | Claim experience satisfaction above the agreed benchmark |
| Grievances | Claim grievances and complaints kept below the agreed level |
Skills and tools
Tools used day to day: Claims management system, Fraud analytics tools, MS Excel, Business dashboards, Grievance systems.
Reporting line and career path
Next roles: Chief Operating Officer, Chief Risk Officer, Chief Executive Officer
Interview questions for a Head of Claims
- How do you settle genuine claims fast while still controlling fraud?
- How do you keep repudiation fair and defensible?
- How do you bring down claim leakage across a large portfolio?
- How do you handle a large disputed claim that reaches the ombudsman?
- How do you keep customer satisfaction high at claim time?
- How do you build and develop a team of surveyors and investigators?
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What does a Head of Claims do?
A Head of Claims leads the claims function of an insurer. They set claims policy and service standards, drive fast, fair settlement of genuine claims, and control fraud and leakage. They keep repudiation fair, handle large and disputed claims, lead the claims team and answer for the settlement ratio and turnaround.
What is a claim settlement ratio?
A claim settlement ratio is the share of claims an insurer settles out of those it receives in a period. A high ratio suggests genuine claims are paid, while very low figures may signal disputes or repudiation. A Head of Claims manages this ratio alongside turnaround and fraud control.
What skills does a Head of Claims need?
The role needs deep claims and policy knowledge, sound settlement judgement, and firm fraud and leakage control, all within regulatory and grievance norms. Add reinsurance coordination, analytics and team leadership, plus the fairness and communication to handle customers at the hardest moment of their policy.