Claims Quality Consultant

Santam Insurance; Cape Town; On-site; ZAR 279,000 - 390,600; Full time

Job summary

A leading insurance provider in Cape Town is looking for a Claims Quality Consultant to monitor interactions and provide quality assurance in claims processing. The ideal candidate should have 3-5 years of experience in the claims environment and knowledge of insurance services. This role involves enhancing performance through training and providing detailed reporting to management.

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 drafting the Quality Assurance Framework.
• Enhance performance through refresher training for existing staff.
• Provide claims and complaint resolution recommendations.
• Engage with relevant stakeholders as required.
• Analyse monthly data for quality assurance.

Skills

Detail orientated

Customer Experience knowledge

Organisational awareness

Process improvement skills

Communication/Interpersonal skills

Business writing skills

People management skills

Ability to work under pressure

Education

Matric

NQF level 5 in insurance (advantageous)

Job description

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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.

KEY 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.
• Conduct 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
• 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
• Enabling innovation
• Driving Strategy

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.

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.