Assessor: Claims

TFG Limited; South Africa; On-site; ZAR 180,000 - 280,000; Full time

Job summary

The Claims Assessor at TFG Insure will be responsible for processing insurance claims from receipt to finalisation and will report to the Team Leader in the Insurance Claims Department. This on-site role is based in Western Cape and requires delivering service within set SLAs while maintaining regulatory compliance.

The ideal candidate has Matric, at least two years of customer service experience and one year of claims assessing, with strong Excel and Word skills, familiarity with claims

Qualifications

• Matric/Grade 12 or equivalent is essential.
• 2 years' customer service experience is essential.
• 1 year minimum claims assessing and validation experience is essential.

Responsibilities

• Manage claims for all insurance products from receipt to finalisation.
• Set customer expectations throughout the claims process.
• Handle incoming and outbound calls on the Insurance Claims Shared call.
• Ensure service levels align with the Claims Management Framework and regulatory requirements.
• Collaborate with internal and external stakeholders to meet customer needs.
• Perform policy administration post-claim to keep policies up to date.

Skills

Customer service

Analytical thinking

Numerical ability

Communication

Education

Matric/Grade 12

Tools

Excel

Word

Claims management systems

Job description

We invest in them because they make us better. We value our people, putting our customer’s first, working fast and smart and doing the right thing. TFG is a diverse, multi- faceted retail lifestyle group, woven into the lives of millions. We exist to genuinely be a part of our customer’s lives and we are passionate about inspiring our customers to live their best lives. Our vision is to create the most remarkable omnichannel experiences for our customers.

The Value Added Services division within TFG offers a host of insurance product in the Life and Non-Life product spectrum to all existing and new TFG customers under the TFG Insure brand. The Insurance Claims Department offers the support function of managing the insurance claims initiated by customers on their existing insurance policies in an event of a claim event.

The Claims Assessor incumbent will be responsible for efficiently processing an insurance claim against a TFG Insure product in line with the terms and conditions of the insurance policy and clearly outlined business processes and turnaround times. The Claims Assessor will report to the Team Leader within the Insurance Claims Department.

Key Responsibilities:

Manage claims for all insurance products on the various claim’s platforms from receipt to finalisation.

Manage customer expectations throughout the claims process.

Manage all incoming and outbound calls on the Insurance Claims Share call within the specified service levels.

Ensure service levels are met in line with the Claims Management Framework and regulatory requirements.

Build a rapport and collaborate with all internal and external stakeholders to effectively manage customer needs.

Ensure FICA screening is conducted during the customer onboarding and claims process.

Policy administration post a claim to ensure all customer’s policies are kept up to date:

Capturing and updating information on various insurance platforms as directed by the policyholder.

Any other policy administrative functions that might be required of them as the need arises.

Qualifications and Experience:

• Must have Matric/Grade 12 or equivalent thereof – Essential
• 2 years customer service experience - Essential
• 1 Year minimum Claims assessing, and validation experience is a requirement – Essential

Skills

Be proficient in Excel, Word

Experience working on Claims Management systems and platforms

Be logical and apply analytical thinking skills

Must have numerical ability

Be able to problem solve, handle objections and conflict.

Be attentive to information and detail

Be organised, thorough and accurate

Have good time management skills

Be assertive and able to work well under pressure

Have a high level of stress tolerance

Be an effective communicator (verbal, written, electronic, and interpersonal)

Be organised and able to work in a systematic manner

Be a team player and be able to work independently when required to.

Behaviours:

Demonstrated knowledge of and skill in adaptability, decision making, interpersonal relations, problem solving, teamwork & written communication

Comfortable and effective influencer.

You need to be flexible as the environment is very dynamic and priorities can change.

Sets ambitious goals and takes focused action to achieve desired outcomes to deliver measurable results

Adapts effectively to situations that are complex, uncertain, or lack guidelines and clear information

Interprets and simplifies complex and contradictory information when resolving organisational problems

Interpreting and applying understanding of key financial indicators to make better business decisions.

Assesses and improves the efficiency, effectiveness, and quality of various work processes

Develops plans and prioritises initiatives that align to the organisational goals and objectives

Effectively adjusts their behaviour, approach, and decision-making based on the situation

Thinks and plans strategically, focusing on the long-term goals and objectives of the organisation

Manage time effectively in order to meet expected deliverables within specified time frame

Please ensure your Line Manager is aware and supports your application.

Preference will be given, but not limited to candidates from designated groups in terms of the Employment Equity Act.

About Us

Who we are is because of our people. They are our greatest asset. TFG is an internationally diversified retail portfolio of 34 speciality lifestyle and apparel brands that Inspire our Customers to live their Best Lives and are woven into the lives of millions. Our vision is to create the most remarkable omnichannel experiences for our customers. TFG is more than a workplace, it's a launchpad for your growth. Join us and explore endless growth opportunities across our diverse brands. We’re a purpose-led business, and on this team, you’ll share the pride of making an impact across a whole industry.

We’re the designers, the makers, the shakers and the teams behind the scenes.

Are you with us?

Job Info

• Job Identification 11462
• Job Schedule Full time
• Locations Western Cape, South Africa (On-site)