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 :18 November 2025