Claims Assessor / Approver

About the position

DESCRIPTION/SYNOPSYS:
A well-established insurance company based in Cape Town is seeking an experienced and detail-oriented Claims Assessor/Approver to join their Administration - Claims Department. This role is responsible for assessing, reviewing, and approving insurance claims with a high degree of accuracy and integrity. The successful candidate will also ensure compliance with internal policies, maintain strict turnaround times, and uphold exceptional service standards. This is an exciting opportunity for a seasoned claims professional who thrives in a deadline-driven and team-oriented environment.

MINIMUM REQUIREMENTS:

• Matric Certificate / NQF Level 4
• RE5 Certification preferred
• At least 5 years' experience in claims assessing and 3 years in claims approval
• Experience across life, funeral, credit life, medical, and group life insurance
• Client service and policy administration experience in the insurance industry
• Strong working knowledge of relevant industry regulations (TCF, POPIA, FAIS Ombud)
• Proficient in Microsoft Office (Excel, Outlook, PowerPoint)
• High attention to detail, excellent writing and communication skills
• Strong organizational skills and ability to maintain confidentiality and accuracy

RESPONSIBILITIES:

• Assess insurance claims using internal checklists and master policy guidelines
• Approve claims while ensuring impartiality, accuracy, and adherence to policy rules
• Verify claim documentation and perform due diligence before authorizing payouts
• Ensure claims are processed within SLA and submitted to Finance with complete banking details
• Communicate with clients for outstanding information and resolve queries timeously
• Manage and update the claims filing system and release claim batches accurately
• Investigate claims for possible fraud and escalate as needed
• Assist with generating letters (paid, repudiation, proof of payment) and registers
• Contribute to risk reporting by logging incidents and updating the risk register
• Foster teamwork by assisting colleagues, escalating issues, and contributing to a transparent work culture

SOFTSKILLS/ADDITIONAL INFO:

• High level of integrity and trustworthiness
• Detail-oriented and deadline-driven
• Effective communicator with strong interpersonal skills
• Ability to remain composed under pressure
• Structured, organized, and methodical in approach
• Collaborative team player who supports knowledge sharing and team goals

Desired Skills:

• High level of integrity
• Detail-oriented
• Deadline-driven

About The Employer:

Do you see yourself as the successful Claims Assessor / Approver at this leading Company? Apply Now. Don't delay.
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Should you meet the above minimum requirements, please submit your CV and a copy of your ID and Qualifications to [Email Address Removed] . Please quote the TITLE of this vacancy in the subject line of your email as reference. Our consultants will assess your suitability to the vacancy. Should you not receive a response within 2 weeks please consider your application unsuccessful, however we will retain your CV and details on our database in accordance with POPIA and will contact you in the near future should a suitable position become available.
You have the option to "opt-out" and request us to delete your information at any time by sending a mail to admin (@) [URL Removed] / info (@) [URL Removed]
Thank you.