Insurance Claim Specialist

3 days ago


Pretoria, Gauteng, South Africa Bettersure Financial Consultants Full time
About BetterSure Financial Consultants

We are a leading provider of innovative financial solutions, dedicated to delivering exceptional customer service and ensuring smooth claims resolution.

Our team is seeking a skilled Life Claims Consultant to join our ranks, responsible for managing the entire claims process, from registration to settlement.

Key Responsibilities:
  1. Claims Processing
    Manage the end-to-end claims process, including registration, validation, and settlement. Ensure all claims are processed within agreed service level agreements (SLAs) and comply with company policies and regulatory requirements.
  2. Client Service
    Communicate with clients and beneficiaries to gather necessary information, explain claims processes, and provide updates. Handle client queries and concerns with empathy and professionalism, ensuring a positive client experience.
  3. Investigation and Assessment
    Verify the validity of life insurance claims by reviewing documentation, including medical reports, death certificates, and policy terms. Identify potential fraud or discrepancies and report any suspicious activity to the Claims Manager.
  4. Compliance and Reporting
    Ensure that all claims handling practices adhere to Treating Customers Fairly (TCF) principles, regulatory requirements, and internal policies. Prepare and submit claims reports to the Claims Manager, highlighting trends, risks, and opportunities for process improvement.
Requirements:
  • Qualifications
    Matric Certificate, RE5, NQF5 Wealth Management, and a tertiary qualification in Insurance, Business Administration, or a related field are required. Relevant certifications in life insurance or claims processing are preferred.
  • Experience
    At least 2 years of experience in life insurance claims processing or a related role is essential. Experience in the insurance or financial services industry is also required.
  • Skillset
    Strong knowledge of life insurance products and claims processes is essential. Excellent communication and interpersonal skills, proficiency in Microsoft Office, and claims management systems are also required.


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