Insurance Claims Specialist at Shoprite Group of Companies

Purpose of the Job    

• To coordinate the accurate assessment, administration, and resolution of insurance claims, ensuring claims are validated against policy requirements, progressed timeously, and resolved in a manner that supports compliant settlement and effective stakeholder service.

Job Objectives    

Claims Administration and Processing

• Coordinate assigned insurance claims from receipt to resolution, ensuring each claim is logged, assessed, tracked, and progressed within agreed turnaround times. 
• Support the claims process by obtaining outstanding information, updating claim records, and ensuring claim files are complete before approval, settlement, or closure.

Claims Validation and Policy Alignment 

• Assess claim details and supporting documentation to confirm validity, completeness, policy coverage, and alignment to claims requirements. 
• Identify claim exceptions, exclusions, inconsistencies, or missing information and escalate cases requiring specialist review, approval, or insurer decision-making. 

Stakeholder Coordination and Query Resolution

• Engage with claimants, insurers, brokers, assessors, repairers, service providers, and internal stakeholders to clarify claim requirements and progress claim outcomes. 
• Provide clear claims feedback, respond to routine queries, and support stakeholders with updates on documentation requirements, claim status, settlement progress, or next steps. 

Risk, Compliance and Record Management

• Apply claims controls to reduce exposure to incorrect payments, incomplete assessments, non-compliant settlements, and potential claims irregularities. 
• Maintain accurate claims documentation, system notes, trackers, and supporting records to ensure auditability, reporting accuracy, and clear claims history. 

Qualifications    

• Grade 12 / National Senior Certificate (essential) 
• Diploma in Insurance, Risk Management, Business Administration, or related field (preferred) 

Experience    

• 1–3 years’ experience in insurance claims administration, short-term insurance, or financial services environment.

Knowledge and Skills    

• Exposure to claims processing, documentation validation, or policy administration is advantageous.

Closing Date    

• 2026/06/26