Claims Specialist: Complex Insurance Assessments & QA

Keen; Cape Town; On-site; ZAR 84,704 - 141,174; Full time

Benefits offered by this job

Professional development budget

Attendance & Timeliness Bonus

Transport Allowance

Monthly Performance Bonus

Collaborative in-office team

Medical Allowance

Job summary

Keen in Salt River, Cape Town, is seeking an experienced Claims Assessor to support accurate processing of high-volume claims within our internal platform. The role focuses on reviewing submissions, validating documents, and applying predefined guidelines with careful judgment.

This full-time, office-based position requires strong English, attention to detail, and the ability to meet SLA targets while handling evening or overnight shifts.

Qualifications

• 1-2 years of claims handling or similar back-office experience.
• Experience in a high-volume, process-driven admin environment.
• Experience with travel, ticketing, mobility, shipping, or purchase protection claims is advantageous.
• Strong attention to detail and the ability to review documentation carefully and make accurate decisions.
• Fluent written and spoken English; ability to follow structured processes and guidelines.
• Good organizational and time management skills.
• Comfortable working within internal systems and managing repetitive workflows with accuracy.
• Ability to identify exceptions and escalate appropriately using edge case judgement.
• Typing speed of 40+ WPM.
• Calm under pressure with strong problem-solving and communication skills.
• Reliable and punctual, with a demonstrated history of professional attendance and accountability.
• Able to receive feedback, follow structured processes, and operate within defined service standards.
• Proven history of working evening or overnight shifts.

Responsibilities

• Review and assess new and reopened claims in line with internal guidelines and settlement authority.
• Process claims exclusively within the internal claims system using approved workflows, templates, and status updates.
• Validate claim information and supporting documents for completeness, accuracy, and eligibility.
• Handle routine claims decisions within defined thresholds and escalate exceptions, appeals, or edge cases to the internal client team.
• Maintain accurate claim records and ensure all required documentation is captured correctly in the system.
• Meet productivity, quality, and SLA targets across daily claims processing volumes.
• Identify potential fraud indicators or inconsistencies and escalate where required.
• Support continuous improvement by flagging process gaps, recurring issues, or workflow inefficiencies.
• Collaborate internally with team leads and quality teams to ensure consistent claims handling standards.
• Follow all operational, compliance, and documentation procedures relevant to claims processing.

Skills

Claims handling

Attention to detail

English proficiency

High-volume processing

Team collaboration

Job description

Keen in Salt River, Cape Town, is seeking an experienced Claims Assessor to support accurate processing of high-volume claims within our internal platform. The role focuses on reviewing submissions, validating documents, and applying predefined guidelines with careful judgment.

This full-time, office-based position requires strong English, attention to detail, and the ability to meet SLA targets while handling evening or overnight shifts.