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Claims Specialist, Accident And Health

Santam Insurance
GautengSouth Africa
4 days ago0 Applicants
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Claims Portfolio

  • Attend to all aspects related to a portfolio of claims e.g. new claims, current files, diary, mail, recoveries, Agg Tracker management, third party claims, attorney/investigator matters, settlement within mandate etc.
  • Negotiate settlement agreements within mandate.
  • Draft settlement agreements.
  • Strategically manage a portfolio of claims.
  • Appoint and manage loss adjusters and attorneys where warranted.
  • Monitor and adhere to service levels in accordance with agreed service level agreements.
  • Monitor legal loss adjuster fee expenditure and refer concerns to management within the framework of agreed internal protocol.


  • Analyse factual and legal issues when assessing claims.
  • Critically analyse facts and their impact on the underlying merits assessment as well as the legal aspects of the policy.
  • Use judgement in making appropriate decisions on merits and policy response.
  • Critically assess and analyse the information required.
  • Conduct a strategic assessment of claims and make strategic decisions on handling of claims.
  • Have an in-depth understanding of technical and legal aspects impacting on the policy’s operation.

System processing

  • Attend to all aspects of system processing relevant to a portfolio of claims e.g. registration of new claims, updating of reserves, cheque requisitions etc.

Client Liaison (Internal and External)

  • Respond to queries and resolve to the satisfaction of the affected parties within the scope of authority and / or responsibility.
  • Maintain and adhere to service levels
  • Prepare for and attend meetings.

General Administration

  • Produce reports when required.
  • Attend to daily administrative routine tasks in accordance with organisational standards, processes and procedures.
  • Attend to the typing of general correspondence if and when necessary.

Qualification and Experience

  • Matric
  • FAIS compliance (within the required period if not a registered Rep)
  • Medical Qualification (if possible)
  • Minimum 6 months A&H claims handling experience a preference
  • Analysis of medical accounts and medical claims handling a preference
  • Assessing medical reports and understanding medical terminology

Knowledge and Skills

  • Ability to strategise and drive a claim to finality
  • Administrative Skills
  • Analysis and Judgement
  • Attention to Detail
  • Client Orientation 
  • Communication Skills including negotiation
  • Follow Up
  • Initiative
  • Interpersonal Skills
  • Organisational Awareness
  • Planning and Organising
  • Teamwork
  • Computer Literacy
  • Time management and ability to manage multiple claims at the same time
  • Attention to detail

Core Competencies

  • Being resilient - Contributing dependently
  • Collaborates - Contributing dependently
  • Cultivates innovation - Contributing dependently
  • Customer focus - Contributing dependently
  • Drives results - Contributing dependently
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About the company
Santam Insurance logo

We are the largest short-term insurer in South Africa, with a market share in excess of 22%, providing short-term insurance products through broker networks and direct sales channels.

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