Claims Administrator

We have a vacancy in Ambledown: Please apply with your updated CV and a one-page motivation letter by the 6th of March 2026.

Qualifications:                      

• Clinical Diploma/Degree
• SANC Registered
• FAIS Compliant

Skills and Experience:

• A minimum of 2 years’ gap cover claims experience
• Technical knowledge on various health insurance products
• Advanced knowledge of ICD Codes, medical procedures and medical aid schemes
• Sound understanding of the Prescribed Minimum Benefits (PMB) legislation in conjunction with gap cover
• Strong computer skills, including Microsoft Office and intermediate to advanced Excel skills
• Excellent customer service, communication, and interpersonal skills
• Advanced Business English (written and verbal)
• Strong attention to detail and accuracy
• Analytical and problem-solving skills with the ability to interpret clinical information
• Ability to take ownership and responsibility for actions and outcomes
• Ability to handle pressure while remaining calm, professional, courteous, and solution-oriented
• Experience in dealing with escalated and/or complex claims queries is an advantage
• Ability to work independently and as part of a team.

Reporting to:

Claims Supervisor  

Scope of Responsibility:

• Assess claims in accordance with policy rules, benefits, and conditions
• Conduct clinical review and validation of pre-existing conditions and casualty claims
• Attend to escalated and complex clinical queries
• Respond to broker and policyholder queries in a timely and professional manner
• Ensure compliance with internal policies, procedures, and regulatory requirements
• Maintain accurate records and documentation of claims assessments and outcomes.
• Contribute to process improvement initiatives within the claims department.
• Any other duties as assigned by the company from time to time.

Changes:

The company reserves the right to change this job description at its sole discretion from time to time.

Posted on 30 Mar 16:12, Closing date 6 May