Complaints Transformation Qorus-NTT DATA Innovation in Insurance Awards 2026

Project Description – Complaints Transformation Concept and Objectives Old Mutual Insure’s Complaints function undertook an end to end transformation to reduce complaint volumes, improve fairness and turnaround times, strengthen regulatory alignment, and uplift customer trust. The core concept combined system enhancements, process controls, quality assurance, customer education, and external reputation management (HelloPeter and Ombud) into a single, integrated operating model. Primary objectives (2025–2026): • Reduce Level 2 complaints and service-related complaints across the value chain • Cut Ombud referrals and overturns through better internal decision quality • Improve customer experience metrics (NPS, trust, star rating, review volumes) • Strengthen Treating Customers Fairly (TCF) outcomes and market conduct alignment • Shorten time to resolution and avoid unnecessary escalations/costs • Create a scalable framework that can be replicated across business units Reasons Behind Prior to the transformation, the team operated on manual-heavy processes with limited staffing, which contributed to longer turnaround times and higher service-related complaints. Additionally, audit findings highlighted the need for tighter controls and consistent application of the framework and PPR. Externally, Ombud referrals and overturns indicated improvement opportunities in internal decisioning, and our public trust signals (HelloPeter) did not match the quality of many resolutions achieved internally. These realities combined with OMI’s ambition to lead on customer fairness and trust catalyzed a coordinated transformation across systems, process, people capability, and reputation management. State of Competition In the South African short-term insurance market, most competitors focus on single lane improvements (e.g., systems only or CX only). OMI’s innovation is differentiated by its holistic model: it pairs digital complaint controls with governance, QA, customer education, and external sentiment strategy, and it institutionalises monthly root cause analysis with management actions. This ecosystem approach not only reduces complaints and Ombud risk but also elevates public trust at scale — a rarity in the market. Sources of Inspiration • TCF and market conduct principles to anchor fairness at every decision point • Voice of Customer and public feedback loops (HelloPeter) to guide service recovery • Ombud stance alignment to ensure internal arbitration mirrors external expectations • Continuous improvement disciplines (root cause analysis, journey mapping) to turn insights into action • Change management best practices to drive adoption across multiple business units Departments Involved This transformation succeeded through cross-functional collaboration: • Complaints Management (program lead; RCA, reporting, governance) • Claims & Underwriting (service improvement actions, TAT optimisation) • Internal Arbitration (IA) Office (independent decisioning; TAT and quality uplift) • Customer Experience / Reputation (HelloPeter strategy, NPS) • Business Unit Operations (on the floor coaching, execution) • Marketing & Communications (Ombud/TCF awareness) • Technology (system enhancements; controls; workflow optimisation) Complaint Reduction & Quality of Resolution • Level 2 complaints down 35% YoY • Complaints as % of active policies: 2.0% → 1.6% • Claims-related complaints down 45%; complaints vs claims registered: 1.8% → 1.1% • Despite limited staffing and manual components, 65% of complaints resolved in favour or partial favour of customers/brokers — preventing NFO escalations and yielding a cost saving of R3,546,000 HelloPeter Reputation & CX Metrics (New Incentive Model from Apr 2025) • Trust Index: 7.2 → 9.6 /10 • Average Star Rating: 3.7 → 4.8 /5 • Review Volume: 62 → 361 average reviews per month • NPS: 27 → 56 /100 • Lower incentives paid out while improving all metrics — a better ROI profile Ombud (NFO) Outcomes • Referrals down 18% (from 2.6/1000 to 1.8/1000 claims) • Material decreases in drivers: o Quantum complaints –38% o Policy condition complaints –28% o Underwriting complaints –26% • Combined overturn rate improved by 8.5%, reflecting better internal fairness and decision quality System, Process & Governance Improvements • Monthly root cause analysis → targeted management actions to prevent recurrence • Ombud Awareness & TCF sessions → better decision alignment with external stances • IA model shift (Specialist → Assistant Internal Arbitrator with mandate to issue Recommendations) o TAT improved from 36 → 31 working days o IA appointed as FTE; independence maintained for credibility and fairness • Customer Education Campaigns continued to improve understanding of cover and escalation mechanisms • On the floor coaching → 12% reduction in claims service related complaints escalated to NFO • Customer Journey Mapping workshops run; improvement actions initiated for 2026 Why This is Innovative The project moves beyond incremental system fixes. It integrates technology, governance, customer education, internal arbitration, and public sentiment management into a single operating model. That integration delivered a simultaneous reduction in complaints, Ombud exposure, costs, and reputational risk, while improving CX and trust signals a step change for OMI and a portable model for other.