Claims Assessor
MVIA
2026/09/17   Southern Suburbs (Cape)

Job Ref #: MVIA_16_2026
Industry: Insurance
Job Type: Permanent
Positions Available: 2
The Claims Fast Track Assessor assesses, validates and settles claims accurately, fairly and in line with company policy, regulatory requirements and service level agreements, while delivering an excellent customer experience.
Job Description

We are looking for a Claims Fast Track Assessor who reads a file quickly, applies policy accurately, decides confidently within mandate, and leaves the customer feeling properly looked after. The Claims Fast Track Assessor assesses, validates and settles claims accurately, fairly and in line with company policy, regulatory requirements and service level agreements, while delivering an excellent customer experience.

Assessment & Evaluation

  • Conduct assessments against established standards, policies and regulatory requirements, reviewing documentation and records to provide quick outcomes.
  • Gather and analyse evidence to support assessment findings.
  • Validate cover, policy terms, conditions, exclusions and premium status before making a decision.
  • Determine liability and quantum on claims and settle within the delegated mandate.
  • Refer claims to the Claims Team Leader or Claims Manager when required in a timely manner.
  • Identify and escalate potential fraud indicators, misrepresentation or non-disclosure accordingly.

Compliance & Quality Assurance

  • Ensure services meet organisational, contractual and regulatory requirements.
  • Identify non-compliance, recommend corrective action and monitor implementation of improvement plans.
  • Apply the Treating Customers Fairly (TCF) outcomes to every claim decision and ensure decisions are consistent and defensible.
  • Work within delegated authority at all times and keep claim reserves accurate and current.

Reporting & Documentation

  • Prepare documentation and maintain accurate and confidential records.
  • Track trends and recurring issues.
  • Record all decisions, rationale and customer interactions on the claims system in full and in real time.

Customer Experience & Stakeholder Liaison

  • Communicate claim outcomes to customers, brokers and intermediaries promptly.
  • Manage expectations proactively on timelines, documentation requirements and next steps.
  • Liaise with service providers, suppliers, assessors and repairers to expedite claim finalisation and control costs.
  • Resolve queries at first point of contact wherever possible and manage complaints in line with the complaints procedure.

Continuous Improvement

  • Ensure continuous accurate assessment, correct application of policy and effective supplier negotiation.
  • Share recurring themes and process friction points with the Team Leader to inform system and process enhancements.
  • Identify opportunities to improve in service delivery and oeprational efficiency.
Job Requirements

Qualifications

  • Grade 12 / National Senior Certificate (NQF Level 4).
  • A relevant tertiary qualification in Insurance, Risk Management, Quality Assurance, Business Administration or a related field (NQF Level 5 or higher) - advantageous.
  • RE5 Regulatory Examination — advantageous

Experience

  • 2–3 years’ claims assessment or claims processing experience within short-term insurance.
  • Proven experience working to service level agreements in a high-volume claims environment.

Competencies

  • Speed with accuracy — able to sustain quality under volume pressure.
  • Sound, decisive judgement within defined authority.
  • Customer focus, empathy and the ability to deliver an unwelcome decision well.
  • Resilience and composure when dealing with distressed or dissatisfied customers.
  • Integrity, ethical conduct and respect for confidentiality.