157 Senior Claims Consultant jobs in South Africa

Responsibilities Financial

• Ensure appropriate minimisation of claims and claims expenses
• Ensure and contribute to minimisation of general expenses

• Ensure that all stakeholder (e.g. clients, AE’s, insurers) communication is accurate, timeous, professional and relevant
• Build and maintain mutually beneficial relationships with internal (e.g. account executives) and external (e.g. clients) stakeholders
• Keep client informed regarding to progression of the claim
• Ensure and contribute to achieving the required client satisfaction targets

• Adhere to company quality standards and broader regulatory frameworks with regards to the following processes (but not limited to):
• Claims Administration
• Receive claims notification, and send and obtain any relevant forms or documents as may be required
• Administer complete claims process according to defined claims procedures until claims are settled
• Appoint assessor or loss adjustor
• Apply policy terms and conditions
• Keep internal system and records up to date at all times
• Keep relevant internal stakeholders up to date on the progress of registered claims
• Make assessment of claims validity and estimate value and administer mandated claims
• Forward claims in excess of mandate to insurer
• Obtain quotes for services
• Arrange approval and payment for claims costs in line with claims and cover
• Act as intermediary between insurer and client and timeously relay communication, requests and documentation
• Follow the recoveries process, diarise follow-ups and keep clients informed
• Ensure productivity targets are met
• Contribute towards and ensure continuous improvement in own and team performance
• Adhere to company mandates
• Participate and contribute in ad hoc projects
• Report any suspected fraud, misrepresentation and/or dishonesty
• Keep accurate record of own activities

• Live the RBS values by committing to the organisational values
• Ensure continuous self-development
• Share information and knowledge with the team

• Matric or equivalent
• RE 5
• FAIS appropriate qualification/credits
• Computer literate
• CIMS - advantageous
• Excellent communication skills (verbal & written)

• 3years claims experience (Personal Lines and Commercial)

Overview

Cape Town, South Africa | Posted on 10/02/2025

We are looking for a dedicated Claims Consultant to join our dynamic team. In this role, you will manage insurance claims efficiently, ensuring timely payments to policyholders and compliance with insurer requirements. You'll assess the validity of claims, identify potential fraud, and coordinate necessary services after accidents or incidents.

• Process new claim notifications and collect necessary documents.
• Analyse and guide policyholders through claims.
• Contact CLC/Origin Assist for assistance arrangements.
• Build relationships with brokers, advisors, staff, and clients.
• Ensure fair customer treatment and escalate complaints.
• Refer complex claims to the Claims Manager.
• Discuss claim problems with Claims Managers.
• Manage binder claims per insurer mandates and follow up in the Diary system.
• Ensure all claim documents are accurate, complete, signed, and compliant with legal and industry guidelines.

• Minimum Qualifications/Certifications: Matric (Grade 12)
• Minimum Experience: 1-2 years experience
• Working Conditions: Hybrid model—work from the office once per week
• Skills & Qualifications: Strong analytical and communication skills.
• Ability to handle complaints professionally.
• Knowledge of insurance policies and regulations.

Job Description,
Co-ordinate and oversee, manage negotiate and settle personal lines and commercial claims and account for the finalisation of the claim end-to-end. Delegate authority to manage the process and resolve any conflict by a negotiating, settlement, and finalisation functionality. Administer and validate claims correctly and efficiently within the specifications of PPS Short-Term Insurance Company's policy terms and conditions.

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Requirements
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Education

• NQF Level 4: Grade 12
• Certificate of Proficiency in related field

Experience

• 5+ years experience in a Short-Term Insurance Claims environment
• Short-term Insurance Industry experience will be advantageous.
• Codeplex experience would be an advantage.

Knowledge And Skills

• Strong communication skills (written & verbal).
• Strong customer service skills.
• Service driven, with a focus on accuracy and quality of information delivered within service levels.
• Strong attention to detail.
• A strong work ethic and a drive to exceed expectations.
• Strong analytic and problem-solving skills.
• Adaptability to different stakeholders, audiences, and environments.

Competencies

• Adapting and responding to change.
• Persuading and influencing.
• Deciding and Initiating Action.
• Coping with pressure.

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Duties and Responsibilities
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Validation of Insurance Claims

• Validate claims in a friendly, courteous, and professional manner to all stakeholders within the prescribed turnaround times as documented and agreed in various service level agreements
• Accurately document all interactions, decisions, and transactions related to the claims process. This includes maintaining detailed records of claim documents, correspondence, and any investigation findings
• Investigate the merits of a specific claim and determine if the services of an assessor / loss adjustor would be required and appoint the most appropriate preferred assessor / loss adjustor where necessary to perform further investigations
• Verify that all requirements are met (e.g. alarm systems, etc) in terms of the policy contract
• Confirmation of conflicting statements with relevant parties
• Make decision within financial mandate and within the set-out processes

Process optimization and efficiencies

• Duties include working with cross-functional teams to deliver exceptional service to all intermediaries/members as set out in the relevant service level agreements
• Combat insurance fraud by ensuring strict compliance to mandates, set procedures, philosophies and Company rules and regulations
• Identify opportunities for process improvements and efficiency enhancements within the claims handling department. Offer feedback and suggestions to enhance customer experience and streamline operations
• Uphold all service excellence principals as communicated by management

Stakeholder Management

• Build and maintain relationships with internal and external stakeholders
• Collaborate effectively with peers to achieve business results

Job Purpose
This Claims Consultant role will be responsible for managing Branch claims assigned, within the branch mandate, within the set standards required by the company thus contributing to the productivity of the claims department. Maintaining the standards of the claims department thus enhancing the image of Hollard, as well as ensuring technical aspects for claims settlement are adhered to. Contribute to the growth and profitability of Hollard and Ensure strong working relationship between all stakeholders.

Key Responsibilities

• Technical expertise: To evaluate and investigate all claims received in order to prevent possible leakage to the company in the settlement of claims.
• Customer service: Maintain a high level of service to customers (internal and external) according to service level agreements and within the service standards as set by the Company.
• Service to brokers: Over and above normal claims processing duties such as technical advice and other assistance.
• Effective and timeous communication: Communicate in a professional manner with internal and external parties and respond to queries within 24 hours.
• Registration: All claims received to be registered within 24 hours of receipt.

Hello… an exciting new opportunity has just become available in our Insure, Broker Distribution. We are looking to recruit a
Claims Consultant
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n the Central Region, BFN.

Role Objectives
Responsible for managing Branch claims assigned, within the branch mandate, within the set standards required by the company thus contributing to the productivity of the claims department. Maintaining the standards of the claims department thus enhancing the image of Hollard, as well as ensuring technical aspects for claims settlement are adhered to. Contribute to the growth and profitability of Hollard and ensure strong working relationship between all stakeholders.

Key Responsibilities

• Technical expertise: To evaluate and investigate all claims received in order to prevent possible leakage to the company in the settlement of claims.
• Customer service: Maintain a high level of service to customers (internal and external) according to service level agreements and within the service standards as set by the Company.
• Service to brokers: Over and above normal claims processing duties such as technical advice and other assistance.
• Effective and timeous communication: Communicate in a professional manner with internal and external parties and respond to queries within 24 hours.
• Registration: All claims received to be registered within 24 hours of receipt.

Introduction

Guardrisk is the undisputed market leader in cell captive insurance and risk solutions. We are renowned for our innovative approach to cell captive structures and other alternative risk transfer solutions for our clients. Guardrisk offers clients custom designed cover and is registered in South Africa as an insurer for all statutory classes of non-life and life insurance business.

Disclaimer

As an applicant, please verify the legitimacy of this job advert on our company career page.

Role Purpose

The FNOL Claims Consultant is responsible for registering new claims received from brokers and appointed service providers within the SLA. This role requires excellent customer service skills, attention to detail, and the ability to work in a fast-paced environment.

Requirements

Qualifications

Diploma or equivalent (required)

NQF Level 4 qualification in insurance

Experience

1–2 years of experience in customer service, insurance, or claims handling (preferred)

Duties & Responsibilities

Claims Intake:

Receive new claims from the designated mailbox, claim to be registered within the SLA.

Appointment of Service Providers is all the information is available at registrations stage.

Verify essential information, such as policy details, date and time of the incident, Incident Address, description of the loss, and contact information.

Data Entry and Documentation:

Accurately enter claim details into the Ski system.

Ensure all information is complete and consistent for further processing.

Initial Assessment:

Appoint the relevant Service Provider on claims if all the information is available and cover is confirmed.

Identify potential red flags, such as fraudulent claims or coverage issues.

Coordination:

Route claims to the appropriate claims technicians or departments based on the type and severity of the loss.

Collaborate with other teams, such as underwriting as needed.

Compliance:

Ensure all claims are handled in compliance with company policies, regulatory requirements, and industry standards.

Follow-Up:

Follow up with claimants to obtain missing information or documentation.

Key Performance Indicators (KPIs):

Accuracy of data entry and documentation.

Number of claims Registered per day/week.

Compliance with regulatory and company standards.

Competencies

Communication Skills:

Excellent verbal and written communication skills to interact with claimants and internal teams effectively.

Customer Service:

Strong customer service orientation with the ability to handle stressful situations empathetically.

Attention to Detail:

High level of accuracy in data entry and documentation.

Problem-Solving:

Ability to quickly assess situations and make decisions.

Time Management:

Ability to prioritize tasks and manage time effectively in a fast-paced environment.

Technical Skills:

Proficiency in using claims systems, Microsoft Office, and other relevant tools.