Claims Specialist - Sapphire

The purpose of the function is to attend to the adjustment and management of claims with the aim of minimising the losses due to the company and approving only those claims that are valid under the Policy. Key Tasks & Accountabilities Effective processing of claimsPrioritise daily activities to enable processing and maintenance of all claims within mandateCheck the accuracy of registered claims cover, details and add claimant details timeouslyConfirm estimate is accurate, deducting excess to work out estimate of claim through investigating policy coverManage Aggregates where applicableComplete fraud list and identify claims that require further fraud verificationEnsure communication is accurate and timeous to relevant broker and loss adjusters as well as lawyers if applicableLiaise with stakeholders to gather and ensure accuracy of informationEnsure applicable claims recoveries are completed Deal with and ensure resolution of queries on an on-going basisObtain necessary documents/assessors report and make amendments to estimates ensuring authorization within policy coverAttend weekly claims meeting and provide update on allocated claims portfoliosLoad or approve payments on relevant system, ensuring accuracy of banking details, invoice number, VAT numbers, class allocation, client release, etcEnsure letters are forwarded to brokers demonstrating breakdown of paymentsEnsure accurate codes are allocated to payment of claims to minimize leakageReview all open files on a quarterly basis by assessing check reports and claims not processed report (Estimate Review)Ensure all FAC notifications are sent out for claims submitted and once payments are done recoveries are obtained from reinsurers within 90 daysEffective customer focus and serviceLiaise with internal stakeholders to facilitate problem resolution and efficiency of work activitiesCommunicate with stakeholders on a daily basis to inform of progress of claims and claim policy and procedureDeal with and resolve any queries relevant to area; if unable to resolve, escalate to manager for resolutionRepresent the organization through maintaining high levels of professionalism, service excellence and customer excellence Adhere to internal policies, processes, and proceduresEffective adherence to company claims policy, standards, and SLAEnsure adherence to all company policies at all timesEnsure adherence to negotiated flexi hoursMaintain dress code, behaviour, and absenteeismRelationshipInternalUnderwriting and finance. External Brokers (Telephonically and Directly), Clients, All Claims Suppliers and Service Providers Qualifications & Experience Minimum Degree or NQF Level 4Minimum 5 years claims handling/ adjustment experience Proven experience in handling of large loss claims, especially cases valued over R1,000,000.00 in Property/ Business Interruption claims.Relevant experience of managing service providers, negotiation, and face to face meetings with stake holders.Sound knowledge, experience and understanding of short-term insuranceGeneral Claims Handling skillsApplications of claims technical guidelinesBasic insight into company strategies and business plansClear understanding of Financial Services compliance frameworkSound knowledge of Sapphires organizational structureIn-depth knowledge and understanding of relevant company policies, processes and proceduresSound internal networkOther RequirementsAccuracyAttention to detailCustomer service orientation (including assertiveness)Oral and written communicationPlanning and organizingProblem solvingSelf-awarenessTeamworkWork standardsGuiding PrincipalsTechnical SkillsComputer and system skillsAdministrative skillsTelephone skillsCommunication skillsNegotiationClosing date :18 November 2025