Claims Assessor Intern (Bellville) at Momentum Metropolitan Holdings Limited

Role Purpose    

• To prepare and recommend payments in line with the claims philosophy.

Requirements    

• Grade 12 or equivalent qualification
• Relevant degree or qualification
• Claims experience preferred
• Experience in a client service or administrative role, preferably within the insurance or financial services industry

Knowledge:

• Understanding of long-term insurance industry and In House systems
• Knowledge and understanding of Insurance Legislation, Pension Fund Act and TCF
• Knowledge and understanding of claims assessment Philosophy and Medical underwriting
• Knowledge and understanding of service admin processes
• Knowledge of the relevant scheme or product rules 

Duties & Responsibilities    
INTERNAL PROCESS:

• Assess and evaluate claims in accordance with policy terms, standard operating procedures, and regulatory requirements.
• Obtain and review all relevant documentation to ensure accurate and fair claim outcomes.
• Recommend claim decisions (approve, decline, or request additional information) in line with delegated authority limits.
• Finalise claims efficiently while ensuring that appropriate requirements are met.
• Monitor and adhere to agreed service level agreements (SLAs) to ensure consistent client service delivery.
• Respond to claims and service-related queries telephonically and in writing within agreed timeframes.
• Investigate and resolve client queries, ensuring accurate and timeous feedback is provided.
• Escalate complex claims or unresolved queries to senior assessors or relevant stakeholders where necessary.
• Process paperless and digital claims in line with operational requirements.
• Maintain accurate and complete records of all claims assessed in accordance with business standards and applicable legislation.
• Provide accurate reporting on claims processed, as required.
• Collaborate with internal stakeholders (e.g., underwriting, policy administration, finance, client services) to ensure seamless claims processing and client experience.
• Contribute to continuous improvement by identifying process inefficiencies and suggesting practical enhancements within the claims environment.
• Actively support both claims assessment and aligned operational functions that ensure service continuity and workflow efficiency. This includes policy reinstatements, assessing premium positions, and performing centralised policy-related administrative functions where required.

CLIENT:

• Provide authoritative expertise to clients and stakeholders.
• Build and maintain relationships with clients and internal and external stakeholders
• Deliver on service level agreements made with clients and internal and external stakeholders in order to ensure that client expectations are managed.
• Make recommendations to improve client service and fair treatment of clients within area of responsibility.
• Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.

PEOPLE:

• Develop and maintain productive and collaborative working relationships with peers and stakeholder.
• Positively influence and participate in change initiatives.
• Continuously develop own expertise in terms of professional, industry and legislation knowledge.
• Contribute to continuous innovation through the development, sharing and implementation of new ideas. Take ownership for driving career development. 

FINANCE:

• Contribute to the financial planning process within area.
• Identify opportunities to enhance cost effectiveness and increase operational efficiency.
• Manage financial and other company resources under your control with due respect.
• Provide input into the risk identification processes and communicate recommendations in the appropriate forum.

Competencies    

• Business Acumen  
• Impact and Influence  
• Leads Change and Innovation
• Collaboration
• Drive for Results
• Diversity and Inclusiveness
• Client/Stakeholder Commitment   
• Self-Awareness and Insight  

Deadline:1st March,2026