Claims Assessor - Cape Town

Rand Mutual Assurance; Cape Town; On-site; ZAR 300 000 - 450 000; Full time

Job summary

A leading assurance company in Cape Town is seeking a Claims Assessor to adjudicate and process claims efficiently. The ideal candidate will ensure accuracy in claims management while providing excellent customer service. This role offers competitive compensation and opportunities for personal development in a stable environment.

Benefits

Competitive salary package

Opportunities for personal and professional development

Teamwork and collaboration-focused environment

Qualifications

• Strong understanding of claims adjudication and management.
• Excellent verbal and written communication skills.
• Ability to work effectively under pressure.

Responsibilities

• Adjudicate and process claims accurately within guidelines.
• Manage claims according to individual targets and timelines.
• Provide effective customer service and manage inquiries.

Skills

Claims processing

Attention to detail

Customer service

Job description

THE JOB AT A GLANCE

As a Claims Assessor, you will be reporting to the Team Leader : Claims Assessor. You will be responsible for adjudicating and processing claims in an effective and efficient manner within the prescribed guidelines set out by Rand Mutual Assurance.

WHAT WILL YOU DO?

Claims Adjudication

• Verify claims captured for correctness and compliance
• Capture / accept additional information on claims i.e. medical reports
• Ensure all documents required to process a claim are indexed and filed into the system
• Add meaningful and accurate notes to ensure complete synopsis of claim on the system
• Update requirements on claims and ensure they are always accurate and up to date.

Claims Management

• Manage claims in line with individual targets
• Review of claims in line with process, authority limits and within agreed timelines
• Escalate where required within authority limits
• Management of medical reports for claims with Permanent Disability
• Communicate claims process to both the employer and employee as set out in the claim’s management processes
• Timeous management of workflows and notifications.

Adjudicate and process payments for claims

>Adjudication and processing of TTD benefits including approval within authority limits
• Adjudicating and processing payment of sundry invoices within authority limits
• Process Permanent Disability claims.

Customer Service

• Regularly communicate and liaise verbally and in writing with customers / suppliers / visitors / enquirers and relevant staff
• Interpret and respond clearly and effectively to spoken requests over the phone or in person, and to verbal or written instructions
• Manage walk-in queries as and when required in line with the RMA Service Catalogue
• Handle customer inquiries both telephonically and by email
• Research required information using available resources
• Provide customers with accurate product and service information in an efficient manner
• Update existing customer personal information on the system
• Deal with all customers in a professional and empathetic manner.

WHAT WILL YOU GET IN RETURN?

We offer great opportunities for personal and professional development in a stable company that is 130 years strong. The role comes with a competitive salary package and various benefits. Furthermore, you will be part of a dedicated group of colleagues who value teamwork and collaboration.

Turnaround time

The shortlisting process will only start once the advert due date has been reached. The time taken to complete this process will depend on how far you progress within the recruitment process and the availability of our managers. Kindly note that should you not receive a response within 21 days, please consider your application unsuccessful.

Closing date: 16th November 2025

Our Commitment to transformation

In accordance with the employment equity plan of Rand Mutual Assurance and its employment equity goals and targets, preference may be given, but is not limited, to candidates from under‑represented designated groups.