Claims Assesor

Who are we? Sanlam Developing Markets [SDM] (a wholly-owned subsidiary of Sanlam Life Limited) is one of the top financial services providers in the South African entry-level and emerging middle market. It aims to understand the unique requirements of clients and offers a wide range of simple and affordable financial solutions that cover needs such as funeral insurance, savings for education, life cover and personal accident plans. In terms of the Sanlam Group Governance Policy, SDM is managed by the SA Retail Mass cluster, which is part of the Sanlam Life and Savings cluster within the Sanlam Group. The cluster focusses on retail products, as well as group schemes. Purpose of the Role To independently assess claims, apply interpretive judgment on coverage and liability, manage customer and intermediary interactions, and ensure balanced risk control and customer experience outcomes. Overview of Role Responsibilities (Level 1-13) Insurance Claims Administration - Level 4 - Process Expert Process assigned straightforward insurance claims, meeting defined customer service standards and ensuring that each claim is supported by valid documentation and supporting evidence. Authorize claims within delegated authority, and refer complex or unresolved issues to senior colleagues. Insurance Claims Evaluation - Level 4 - Process Expert Interview and/or visit claimants to evaluate straightforward low-value claims. Determine the value of insured losses in line with the organization's claims policies and the contractual terms of the insurance policy, referring complex or disputed claims to senior colleagues for resolution. Document Preparation - Level 4 - Process Expert Prepare moderately complex documents using a variety of applications for technology devices, such as standard office software. Also responsible for gathering and summarizing data for reports. Operational Compliance - Level 4 - Process Expert Develop knowledge and understanding of the organization's policies and procedures and of relevant regulatory codes and codes of conduct to ensure own work adheres to those standards. Obtain authorization from a supervisor or manager for any exceptions from mandatory procedure. Operational Risk Management - Level 4 - Process Expert Perform in-depth operational risk assessments and develop appropriate mitigation tactics for complex situations. Ensure all claims processing aligns with SLA requirements and SOPs - Level 4 - Process Expert Apply expert knowledge of policies, procedures, and service standards to ensure compliant and efficient claim management. Customer Service Management- Level 4 – Process Expert Deliver effective customer service by responding to client queries, providing guidance on claim requirements, managing claim-related correspondence, and ensuring a positive client experience through timely resolution of enquiries. Required Skills Claims Management - Intermediate Works at an intermediate level to handle individual and portfolios of claims cost effectively, minimizing claims leakage, and meeting organizational and customer claims service standards. Typically works with guidance. Claims Handling - Intermediate Works at an intermediate level to use and apply processes and procedures for processing claims by an intermediary. Typically works with guidance. Claims Settlement - Intermediate Works at an intermediate level to agree quantum and settle claims, identifying any opportunities for recoveries and its application. Typically works with guidance. Claims Notification and Investigation - Intermediate Works at an intermediate level to use and apply the claims notification process, and validate and investigate claims. Typically works with guidance. Insurance Principles and Practice - Intermediate Works at an intermediate level to use and apply the core principles of insurance. Typically works with guidance. Insurance Products and Services - Intermediate Works at an intermediate level to use and apply the full range of insurance products and services in the market. Typically works with guidance. Education Grade 12 (Matric) or higher qualification. General Experience Sound experience and understanding of straightforward procedures or systems (Minimum 1 year) Required Behavioural Competencies Ensures Accountability Financial Acumen Optimises Work Processes Manages Complexity Communicates Effectively Decision Quality The Sanlam Group is committed to achieving transformation and embraces diversity. This commitment is what drives us to achieve a diverse, inclusive and equitable workplace as we believe that these are key components to ensuring a thriving and sustainable business in South Africa. The Group's Employment Equity plan and targets will be considered as part of the selection process.