Senior Claims Negotiator at Shoprite Group of Companies

About the role    

• To independently assess, negotiate and resolve complex insurance claims within an allocated mandate, ensuring fair, accurate and timely outcomes in line with policy terms, regulatory requirements and service standards.
• The role provides technical claims guidance, manages escalated matters, builds effective relationships with brokers and service providers, and supports the development of less experienced claims staff.

What you'll do    

Claims Assessment and Decision-Making:

• Manage assigned claims from registration through to settlement or closure, ensuring accurate processing and clear ownership throughout the claims lifecycle.
• Assess complex and high-value claims against policy wording, cover, exclusions, endorsements, warranties and applicable claims requirements.
• Apply sound judgement to determine claim validity, liability, quantum and the appropriate resolution within the allocated authority mandate.
• Authorise claims and payments within mandate and prepare clear recommendations for claims requiring higher-level approval.
• Set and maintain accurate claim reserves based on available information, expected exposure and changes in claim circumstances.
• Identify possible fraud, misrepresentation, non-disclosure, recovery or repudiation indicators and refer matters for specialist investigation or approval.

Claims Negotiation and Resolution:

• Negotiate appropriate claim outcomes with brokers, claimants, assessors, attorneys, repairers and other service providers, balancing policy obligations, customer fairness and cost control.
• Evaluate quotations, assessment reports, loss calculations and supporting evidence to agree reasonable repair, replacement, cash settlement or liability outcomes.
• Resolve disputed, sensitive or escalated claims through clear policy interpretation, fact-based engagement and practical solution finding.
• Communicate settlement, partial settlement, rejection or repudiation decisions clearly, professionally and with appropriate supporting reasons.
• Drive outstanding actions and documentation to conclusion, ensuring claims are progressed within agreed service levels and diary requirements.
• Identify and pursue recoveries, salvage opportunities, third-party contributions or other cost-reduction actions where applicable.

Stakeholder Service and Relationship Management:

• Act as a senior point of contact for complex claims queries and provide timely, accurate updates on requirements, progress, decisions and next steps.
• Build constructive working relationships with brokers, insurers, assessors, suppliers and internal stakeholders to support efficient claims resolution.
• Manage difficult conversations and service concerns professionally, escalating material risks or unresolved disputes when required.
• Monitor service-provider performance on assigned matters and address delays, quality concerns or unreasonable costs.
• Support the maintenance and administration of allocated schemes or portfolios, including the consistent application of agreed claims arrangements.

Risk, Compliance and Claims Quality:

• Ensure claims decisions and records comply with policy wording, internal controls, delegated authority, regulatory requirements and applicable service standards.
• Maintain complete and accurate electronic claim files, including correspondence, system notes, supporting documents, approvals, payments and closure information.
• Review claim information for inconsistencies, control gaps, leakage and emerging risk trends, and recommend corrective action where required.
• Prepare claims information for audits, reviews, complaints, regulatory enquiries and management reporting.
• Protect confidential and personal information and apply appropriate data-handling practices throughout the claims process.

Technical Support and Team Contribution:

• Provide technical guidance to claims staff on policy interpretation, negotiation approach, reserving, documentation and claims procedures.
• Coach and support less experienced colleagues through case reviews, feedback and practical knowledge sharing.
• Assist with onboarding and training activities and promote consistent claims standards across the team.
• Contribute to process improvements by identifying recurring issues, inefficiencies and opportunities to improve claims quality and turnaround times.
• Coordinate effectively across claims and other business areas to resolve dependencies and support shared service objectives.

What you bring    

• Degree or Diploma in insurance, risk management, business or claims qualification (essential).
• RE5 qualification and compliance with applicable FAIS fit and proper requirements, where required for the portfolio.
• +4 years’ relevant short-term insurance claims experience, including experience handling complex or high-value claims.
• Demonstrated experience in claims assessment, negotiation, policy interpretation, reserving and settlement within an allocated mandate.
• Experience providing technical guidance, coaching or on-the-job support to other claims staff.
• Proficiency in claims administration systems and Microsoft Office, particularly Outlook, Word and Excel.

Closing Date    

• 2026/10/30