Claims Quality Consultant

Sanlam; Bellville; On-site; ZAR 400 000 - 600 000; Full time

Job summary

A leading insurance provider in Bellville seeks a Claims Quality Consultant to monitor interactions, enhance staff performance, and conduct audits. The ideal candidate will have 3-5 years in the claims environment, strong analytical and communication skills. This role offers an opportunity to engage with various stakeholders and implement quality assurance frameworks.

Qualifications

• Minimum of 3 - 5 years of working experience in the claims environment.
• Knowledge and experience in short-term and insurance services.
• Experience in direct claims would be an added advantage.

Responsibilities

• Contribute toward the drafting and implementation of the Quality Assurance Framework.
• Enhance performance of the claims environment through refresher training.
• Provide claims and complaint resolution recommendations to management.
• Provide monthly reports to the management on reviews conducted.
• Maintain statistical information and analyze monthly data.

Skills

Detail orientated

Customer Experience knowledge (VOX)

Working knowledge of the auditing processes

Process improvement skills

Communication/Interpersonal skills

Business writing skills

Must have people management skills

Ability to work under pressure

Education

Matric

NQF level 5 in insurance (advantageous)

Job description

Overview

Santam Tailored Claims Solutions has a position available for a Claims Quality Consultant, based in Belville, Cape Town.

Job Description

The Claims Quality Consultant monitors and analyses the interactions of Client Service Consultants, Desktop Assessors, and clients to provide feedback on adherence to policies, procedures, and customer experience whilst maintaining relationships with Business Partners.

The role identifies opportunities for assessments and coaching of staff for training or process improvement while facilitating employee development. The Quality consultant will execute audit assessments of both live and historical interactions. Process improvement initiatives, Qualitative and quantitative reporting (daily, weekly, and monthly performance, trend analysis, complaints resolution, and calibration) will also form an integral part of the job requirement.

Responsibilities

• Contribute toward the drafting, design and implementation of the Quality Assurance Framework specific to Client Service Manager
• Enhance performance of the claims environment through refresher training for existing staff, conducting reviews, following a take on process, and on the job training and onboarding for new recruits.
• Provide claims and complaint resolution recommendations to the Client Service Manager based on quality assurance findings.
• Provide monthly reports to the Client Service Manager on reviews conducted, recommendations, timelines as well as progress relating to finalization.
• Engage with relevant stakeholders where required.
• Maintain statistical information.
• Analyse Monthly data, in conjunction with relevant specialists in order to understand trends for purposes of quality assurance requirements.
• Bi-weekly meetings with partners to manage process and areas of concern.
• Perform claims & complaint specific technical and procedural audits
• Conducting due diligence on any new potential partner.
• Providing onboarding to a new partner, in conjunction with the claims & complaints specialists.

Qualifications and Experience

• Matric
• Minimum of 3 - 5 years of working experience in the claims environment.
• Knowledge and experience in short-term and insurance services.
• NQF level 5 in insurance (advantageous)
• Experience in direct claims would be an added advantage

Knowledge and Skills

• Detail orientated
• Customer Experience knowledge (VOX)
• Working knowledge of the auditing processes
• Organisational awareness
• Process improvement skills
• Innovation/Drive
• Communication/Interpersonal skills
• Business writing skills
• Experience in high volume processes management
• Must have people management skills
• Knowledge of motor and non-motor claims process
• Ability to work under pressure

Competencies

• Deciding and Initiating Action
• Client Service Orientation
• Teamwork and Support
• Building Relationships
• Problem Solving
• Performing under Pressure
• Enabling innovation
• Driving Strategy
• Emotional Intelligence

About the Company

Santam is the market leader in the general insurance industry in Southern Africa. As a large, diversified, and expanding company, we are committed to transformation and growth. While our headquarters are in South Africa, we are rapidly extending our presence into emerging markets across Africa and Asia.

With a client base of over 1 million policyholders, Santam serves individuals, commercial enterprises, specialist business owners, and institutions—including 80 of the Top 100 companies listed on the JSE. Our commitment to Insurance, Good and Proper goes beyond just providing cover—we offer peace of mind, ensuring our clients can focus on living in the moment, not worrying about the unexpected. Because at Santam, we believe the freedom to seize every day is worth protecting.

People drive our business, and we are committed to attracting the best talent, whether for permanent roles or short-term opportunities.

Santam is committed to diversity, inclusion, and belonging. As an equal opportunity employer, we encourage applications from candidates of all backgrounds, including persons with disabilities. We are dedicated to neuro-inclusivity and fostering a workplace where everyone can thrive.