335 Healthcare Claims jobs in South Africa

Responsibilities

• Receive approaches from uninsured and insured third parties, acknowledge receipt.
• Register and validate third party only claims.
• Assess and confirm merits of the claims.
• Request quantum/outstanding documents from the third party if applicable.
• Decide if claim is payable based on documentation provided.
• Appoint assessor based on claim specification.
• Provide updates to third party and insured/broker.
• Review assessment and draft offer for third party.
• Negotiate fair offer with third party.
• Send offer and facilitate settlement of signed offer.
• Close files once settled.
• Record savings on spreadsheet.
• Maintain relationship with assessors, other insurers and broker/insureds.
• (Litigation) Receive Summons and acknowledge receipt.
• Verify legitimacy of claim.
• Review summons and decide on action.
• Appoint attorney based on summon’s specification.
• Provide attorney with instruction and documents.
• Follow up with attorney.
• Guide attorney on acceptable offer and parameters of negotiating.
• Settle attorney fees based on acceptable fee scale.
• Negotiate with attorneys on fees based on settlements.
• Maintain relationship with attorneys and investigators.

• Negotiation Skills
• Conflict resolution skills
• Math Skills
• Good Communication Skills
• Interpersonal Skills

At AIG, we value in-person collaboration as a vital part of our culture, which is why we ask our team members to be primarily in the office. This approach helps us work together effectively and create a supportive, connected environment for our team and clients alike.

Enjoy benefits that take care of what matters

At AIG, our people are our greatest asset. We know how important it is to protect and invest in what’s most important to you. That is why we created our Total Rewards Program, a comprehensive benefits package that extends beyond time spent at work to offer benefits focused on your health, wellbeing and financial security—as well as your professional development—to bring peace of mind to you and your family.

Reimagining insurance to make a bigger difference to the world

American International Group, Inc. (AIG) is a global leader in commercial and personal insurance solutions; we are one of the world’s most far-reaching property casualty networks. It is an exciting time to join us — across our operations, we are thinking in new and innovative ways to deliver ever-better solutions to our customers. At AIG, you can go further to support individuals, businesses, and communities, helping them to manage risk, respond to times of uncertainty and discover new potential. We invest in our largest asset, our people, through continuous learning and development, in a culture that celebrates everyone for who they are and what they want to become.

Welcome to a culture of inclusion

We’re committed to creating a culture that truly respects and celebrates each other’s talents, backgrounds, cultures, opinions and goals. We foster a culture of inclusion and belonging through learning, cultural awareness activities and Employee Resource Groups (ERGs). With global chapters, ERGs are a cornerstone for our culture of inclusion. The talent of our people is one of AIG’s greatest assets, and we are honored that our drive for positive change has been recognized by numerous recent awards and accreditations.

AIG provides equal opportunity to all qualified individuals regardless of race, color, religion, age, gender, gender expression, national origin, veteran status, disability or any other legally protected categories.

AIG is committed to working with and providing reasonable accommodations to job applicants and employees with disabilities. If you believe you need a reasonable accommodation, please send an email to

Preference will be given to previously disadvantaged candidates in line with the company’s Employment Equity Plan. Specific preference will be given to people with disabilities.

Functional Area: CL - Claims AIG South Africa

Requirements:

• Grade 12
• Clear criminal and credit record.
• Advantageous:
• Knowledge of microinsurance claims and complaints regulations,
• Knowledge of Treating Customers Fairly principles,
• Additional South African Languages,
• Knowledge of Lewis Stores processes and procedures.

Ideal Experience:

• 3 years + experience in a managerial position (incl assistant management position)
• Claims and Complaints handling.

Competencies:

• Proficient in English
• Computer literate in MS Office (Word, Outlook and Excel)
• Proficient communication skills verbally and written
• Able to manage a team effectively
• Attention to detail
• Self-motivated, committed and a driver of performance
• Disciplined in meeting deadlines and agreed targets

Responsibilities:

Insurance claims – MANAGE CLAIMS ASSESSMENT team, REVIEW ASSESSMENT, assist & REPORT:

• Reporting into the Insurance Claims Manager.
• A team of Customer Protection Insurance claims clerks will report into you.
• Review and approve the assessment of authorised, declined or queried Customer Protection Insurance claims.
• Monitor daily claims reports and assist claims clerks to resolve difficult claims that are not being finalised.
• Ensure that the 48-hour SLA report and Pending Preview report is cleared daily by the claims team.
• Ensure that the Pending Complete report is followed-up and cleared daily and where required follow-up with Lewis Stores Branch Accounts regarding outstanding journals.
• Ensure that the Stock Replacement report is followed-up daily and escalate goods replacements with Lewis Stores senior management where required.
• Monitor the Claims Indexing clerk's workload through the incoming claims mailbox and Papertrail indexing queue and ensure that emails and incoming documents are cleared daily.
• Manage and guide the claims clerks daily to finalise claim assessments efficiently when dealing with queries, follow-up, goods replacements etc. as the claims team works with customers lodging a claim, branch operational staff, and/or head office branch accounts.
• Monitor claims follow-up processing ensuring approved processes and procedures are followed.
• Ensure that claim escalations or disputes are referred to Monarch senior management in a timely manner.
• Prepare and attend daily/weekly claims meetings with your claims team and management.
• Monitor claims team in line with the criteria documented in the monthly / quarterly staff incentive letters.
• Assist senior management with queries and / or follow-up requests from the insurance regulator (PA / FSCA), the National Finance Ombuds Scheme, South African Insurance Association (SAIA), South African Special Risks Insurance Association (SASRIA) etc.
• Assist with providing information on claims queries received from e.g.: the Lewis Stores finance department, Lewis Stores Internal Audit department or management.

STAFF MANAGEMENT – CLAIMS

• Monitor daily attendance and report to Insurance Claims Manager incorrect clock-ins where required.
• Monitor and request overtime and leave requests with the Insurance Claims Manager.
• Assist the Insurance Claims Manager to conduct interviews for claim clerk vacancies when necessary.
• Attend to daily staffing needs and queries.
• Assist with further developments/improvements where necessary.
• Identify areas of training needs.

Job Type: Full-time

Work Location: In person

• Make and receive calls to clients
• Gather and follow up all info and documents required to register claims
• Advise on claims under what section covered on policies
• Interact and follow up with Insurers
• Involvement with claims intermediary service (Client satisfaction)
• Follow claims through to Agreement of Loss and signed by client
• Use logic and intellect to ensure customers are treated fairly
• Build trust-based relationships with clients

Key Skills and Competencies:

• Good verbal and written communication skills at all levels
• Computer literate in Microsoft Office and internet
• Self-discipline and time management
• Punctuality

Role Overview

As a Short Term Insurance Claims Administrator , you will provide end-to-end claims support across Commercial, Personal, and Motor Lines . You’ll play a key role in ensuring efficient claims processing, maintaining high service standards, and supporting brokers in achieving business objectives.

Claims Administration & Management

• Receive and process claims notifications across Commercial, Personal, and Motor portfolios.
• Assess claims validity, estimate values, and apply policy terms and conditions.
• Appoint assessors or loss adjusters and manage claims to resolution.
• Maintain accurate records and ensure compliance with internal and regulatory standards.
• Liaise between clients and insurers to ensure timely communication and resolution.
• Follow up on recoveries and ensure clients are kept informed throughout the process.

Client & Stakeholder Engagement

• Deliver professional, timely communication to clients, account executives, and insurers.
• Build and maintain strong relationships with internal and external stakeholders.
• Support client satisfaction goals through proactive claims handling.

Operational Excellence

• Contribute to reducing claims expenses and improving operational efficiency.
• Meet productivity and performance targets.
• Report suspected fraud or irregularities and maintain meticulous documentation.

Learning & Growth

• Embrace continuous development and share knowledge with the team.
• Align with company values and contribute to a culture of excellence.

• Matric or equivalent.
• Minimum 3 years’ experience in Short Term Insurance Claims (Commercial, Personal, and Motor).
• Strong communication skills (verbal and written).
• Proficient in computer systems and claims platforms.
• Set up for remote work in the event of loadshedding or internet failure.

Insurance Claims Operations Manager - Gauteng, Centurion Overview

MAIN PURPOSE OF THE JOB: Develop functional unit business plans for both the life and non-life insurance business to contribute to the achievement of strategic objectives of the organisation. Oversee the effective functioning of claims management processes across all product lines to drive efficient client serving and customer centricity.

• Honours BCom in Finance, Business Management, Risk Management and Insurance
• 8-10 years Non-life Insurance operations and claims experience
• 8-10 years Insurance operating system experience

Candidates must have the following qualifications:

• Grade 12

Competence:

• Experience (1+ Years in industry)
• Class of Business completed for STI Personal and Commercial lines
• Operational Ability
• Product Specific Training

The following additional factors will be to your (Candidates) advantage:

• Experience on SANTAM online system
• Product specific training completed with main players in insurance industry: Santam, Old Mutual, Momentum (Previously Alexander Forbes), Bryte et

Main characteristics / strong points for candidates:

• Good verbal- and written communication skills at all levels
• Computer literate in Microsoft office and internet
• Self-discipline and time management
• Punctuality
• Make and receive calls to clients
• Gathering and follow up all info and documents required to register claim.
• Advise on claims under what section covered on policies.
• Interaction and follow up with Insurers
• Involvement with claims intermediary service (Client satisfied).
• Follow claim through to Agreement of Loss and signed by client.
• Logic and intellect to ensure customers treated fairly.
• Build relationships (Trust) with clients