Insurance Claims Specialist

Purpose of the Job: To coordinate the accurate assessment, administration, and resolution of insurance claims, ensuring claims are validated against policy requirements, progressed timeously, and resolved in a manner that supports compliant settlement and effective stakeholder service.

Job Objectives

• Claims Administration and Processing Coordinate assigned insurance claims from receipt to resolution, ensuring each claim is logged, assessed, tracked, and progressed within agreed turnaround times. Support the claims process by obtaining outstanding information, updating claim records, and ensuring claim files are complete before approval, settlement, or closure.
• Claims Validation and Policy Alignment Assess claim details and supporting documentation to confirm validity, completeness, policy coverage, and alignment to claims requirements. Identify claim exceptions, exclusions, inconsistencies, or missing information and escalate cases requiring specialist review, approval, or insurer decision-making.
• Stakeholder Coordination and Query Resolution Engage with claimants, insurers, brokers, assessors, repairers, service providers, and internal stakeholders to clarify claim requirements and progress claim outcomes. Provide clear claims feedback, respond to routine queries, and support stakeholders with updates on documentation requirements, claim status, settlement progress, or next steps.
• Risk, Compliance and Record Management Apply claims controls to reduce exposure to incorrect payments, incomplete assessments, non-compliant settlements, and potential claims irregularities. Maintain accurate claims documentation, system notes, trackers, and supporting records to ensure auditability, reporting accuracy, and clear claims history.

Qualifications

Grade 12 / National Senior Certificate (essential) Diploma in Insurance, Risk Management, Business Administration, or related field (preferred)

Experience

1–3 years’ experience in insurance claims administration, short-term insurance, or financial services environment.

Knowledge and Skills

Exposure to claims processing, documentation validation, or policy administration is advantageous.