Claims Consultant

Purpose of the Role 

The Claims Consultant manages and processes insurance claims efficiently and professionally, ensuring fair outcomes for clients while protecting the company's interests. Our claims process runs through several stages: Assessor 1, Assessor 2, Sign-off and Payments. The consultant may be placed in any stage, depending on operational need. In each stage, the consultant owns the claims in their hands, makes sure they are handled correctly against policy terms, and moves them through the process within the agreed turnaround times (TATs) for that stage. Clients are kept informed throughout. This is a fast-paced, high-volume, high-pressure environment. It needs a mature person with strong insurance knowledge, close attention to detail, good time management and a calm, professional manner with clients. 

Key Responsibilities 

Claims Management & Ownership 

• Receive, register, assess and process claims in line with policy terms, conditions and exclusions, at whichever stage you're placed in. 

• Request, obtain and verify all supporting documentation, so that every claim file is complete and accurate before it moves forward. 

• Own each claim at your stage and move it on within the agreed stage TATs, so that claims are settled on time and correctly. 

• Track claim progress, follow up on outstanding requirements, and escalate delays or red flags promptly (e.g. suspected fraud or non-disclosure). 

• Manage a high volume of claims at the same time without compromising quality or accuracy. 

Client Interaction 

• Give clients empathetic, professional support throughout the claims process. 

• Give regular, proactive updates on claim status and outstanding requirements. 

• Explain claims procedures and policy cover to clients. Communicate claim outcomes clearly, in plain language and with empathy, including in difficult conversations. 

• Handle queries and complaints calmly and professionally under pressure. 
  

Time & Workload Management 

• Prioritise and plan the daily workload to meet productivity targets and agreed stage TATs. 

• Work at pace without losing accuracy, so that no claim stalls at any stage. 

Compliance & Documentation 

• Keep accurate, complete and up-to-date records of all claim activity and client communication on the claims system. 

• Double-check critical details (ID numbers, policy information, banking details) to prevent errors further down the process. 

• Handle all claims in line with TCF, PPR, POPIA and internal policies and procedures. 

Stakeholder Coordination 

• Hand claims over to the next stage with a complete, well-documented file and clear notes. 

• Liaise with brokers, underwriters, assessors, legal teams and service providers. 

• Work with internal departments to resolve complex or escalated claims. 

Continuous Improvement 

• Take part in training and development, and suggest improvements where bottlenecks or recurring issues come up. 

Required Qualifications & Experience 

• Matric (Grade 12) – required. 

• At least one year of insurance claims handling experience (short- or long-term), ideally in a client-facing or assessing role. 

• Strong understanding of insurance principles (PPR & TCF), policy interpretation and claims procedures. 

• Proven ability to handle high volumes and consistently meet strict TATs under pressure. 

• Excellent verbal and written communication skills. 

• Computer literate (MS Office); experience on a claims administration system is an advantage. 

• RE5 certification – preferred, not mandatory. 

Key Competencies 

• Attention to detail: accurate, thorough and consistent, even at high volumes. 

• Time management: prioritises, plans and consistently meets deadlines. 

• Resilience: calm, focused and professional under pressure. 

• Client focus: empathetic, patient and committed to fair client outcomes. 

• Ownership & accountability: takes responsibility for each claim and follows it through. 

• Integrity: professional and honest, with high emotional intelligence.