Claims Consultant - Pretoria
Job Overview:
The overall purpose of the Claims Administration role is to ensure the efficient and accurate processing of insurance claims in both short and long-term insurance lines. Attention to detail, strong communication skills, and in-depth knowledge of insurance procedures will contribute to maintaining high levels of client satisfaction and operational excellence.
Roles and responsibilities
- Oversee the end-to-end claims administration process, including reviewing claims documentation, assessing validity, and determining coverage.
- Collaborate with internal teams, such as underwriters and claims adjusters, to gather necessary information for claim evaluation.
- Analyse and evaluate claims to ensure they adhere to company policies, regulatory requirements, and industry best practices.
- Make well-informed decisions regarding claims approval, denial, or negotiation within established authority limits.
- Communicate with policyholders and other relevant parties to provide updates on claim status, requirements, and resolutions.
- Assist claims administrators, providing guidance and support to ensure consistent and accurate claim handling.
Required qualifications, experience and skills
- Matric
- RE5 qualification
- Minimum of 5 years of relevant experience in claims administration within the insurance industry, preferably in both short and long-term insurance.
- Proficiency in using claims management software and Microsoft Office suite.
- Strong understanding of insurance products, policy terms, and claims processes.
- In-depth knowledge of insurance regulations, compliance, and ethical standards.
- Excellent analytical skills to assess claim validity and determine appropriate coverage.
- Exceptional attention to detail and accuracy in reviewing and processing claims documentation.
- Effective communication skills, both written and verbal, to interact with internal teams, policyholders, and external partners.
- Ability to work collaboratively in a fast-paced environment while managing multiple priorities.
- Problem-solving mindset and the ability to make sound decisions under pressure.
Note: This job specification is provided as a general guideline. Specific responsibilities and qualifications may vary based on the unique requirements of the position and the organization's evolving needs.
The incumbent may be required to perform job related tasks other than that which is specified in this job description. This job description is subject to regular review.
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