Claims Specialist

The purpose of the function is to attend to the adjustment and management of claims with the aim of minimising the losses due to the company and approving only those claims that are valid under the Policy.

Key Tasks & Accountabilities

Effective processing of claims

• Prioritise daily activities to enable processing and maintenance of all claims within mandate
• Check the accuracy of registered claims cover, details and add claimant details timeously
• Confirm estimate is accurate, deducting excess to work out estimate of claim through investigating policy cover
• Manage Aggregates where applicable
• Complete fraud list and identify claims that require further fraud verification
• Ensure communication is accurate and timeous to relevant broker and loss adjusters as well as lawyers if applicable
• Liaise with stakeholders to gather and ensure accuracy of information
• Ensure applicable claims recoveries are completed
• Deal with and ensure resolution of queries on an on-going basis
• Obtain necessary documents/assessors report and make amendments to estimates ensuring authorization within policy cover
• Attend weekly claims meeting and provide update on allocated claims portfolios
• Load or approve payments on relevant system, ensuring accuracy of banking details, invoice number, VAT numbers, class allocation, client release, etc
• Ensure letters are forwarded to brokers demonstrating breakdown of payments
• Ensure accurate codes are allocated to payment of claims to minimize leakage
• Review all open files on a quarterly basis by assessing check reports and claims not processed report (Estimate Review)
• Ensure all FAC notifications are sent out for claims submitted and once payments are done recoveries are obtained from reinsurers within 90 days

Effective customer focus and service

• Liaise with internal stakeholders to facilitate problem resolution and efficiency of work activities
• Communicate with stakeholders on a daily basis to inform of progress of claims and claim policy and procedure
• Deal with and resolve any queries relevant to area; if unable to resolve, escalate to manager for resolution
• Represent the organization through maintaining high levels of professionalism, service excellence and customer excellence
• Adhere to internal policies, processes, and procedures

Effective adherence to company claims policy, standards, and SLA

• Ensure adherence to all company policies at all times
• Ensure adherence to negotiated flexi hours
• Maintain dress code, behaviour, and absenteeism

Relationship

Internal

Underwriting and finance.

External

Brokers (Telephonically and Directly), Clients, All Claims Suppliers and Service Providers

Qualifications & Experience

• Minimum Degree or NQF Level 4
• Minimum 5 years claims handling/ adjustment experience
• Proven experience in handling of large loss claims, especially cases valued over R1,000,000.00 in Property/ Business Interruption claims.
• Relevant experience of managing service providers, negotiation, and face to face meetings with stake holders.
• Sound knowledge, experience and understanding of short-term insurance
• General Claims Handling skills
• Applications of claims technical guidelines
• Basic insight into company strategies and business plans
• Clear understanding of Financial Services compliance framework
• Sound knowledge of Sapphires organizational structure
• In-depth knowledge and understanding of relevant company policies, processes and procedures
• Sound internal network

Other Requirements

• Accuracy
• Attention to detail
• Customer service orientation (including assertiveness)
• Oral and written communication
• Planning and organizing
• Problem solving
• Self-awareness
• Teamwork
• Work standards
• Guiding Principals

Technical Skills

• Computer and system skills
• Administrative skills
• Telephone skills
• Communication skills
• Negotiation

Closing date :17 December 2025