JOB CLASSIFICATION

Job Requisition: 141356
TA Specialist: Refilwe Falatsi
Closing Date: 13 August 2025
Location: 135 Rivonia Campus, Sandown
Cluster: Personal and Private Banking | Nedbank Insurance | Operations - Claims
Please Note: Preference will be given to applicants from Underrepresented Groups
FAIS Affected
FAIS Affected - Yes

JOB PURPOSE

To provide claims administration support in respect of short term insurance matters to stakeholders in line with Nedbank strategy.

JOB RESPONSIBILITIES

• Assess and process motor insurance claims in accordance with policy terms and regulatory requirements.
• Communicate effectively with policyholders, and service providers to gather necessary documentation and clarify claim details.
• Investigate claim circumstances, validate coverage, and determine liability.
• Ensure accurate and timely claim updates, and closure within system guidelines.
• Collaborate with internal teams (e.g., underwriting, legal, finance) to resolve complex claims and escalate where necessary.
• Approve rejection letters and ensure they are aligned with policy terms, regulatory standards, and internal guidelines.
• Review and approve claims that exceed the TPA mandate, ensuring accuracy, fairness, and cost control.
• Provide oversight and support to the TPA, ensuring escalated claims are handled appropriately and within agreed service levels. Approve rejection letters and ensure they are aligned with policy terms, regulatory standards, and internal guidelines.
• Review and approve claims that exceed the TPA mandate, ensuring accuracy, fairness, and cost control.
• Provide oversight and support to the TPA, ensuring escalated claims are handled appropriately and within agreed service levels.
• Maintain high standards of customer service, ensuring empathy and professionalism in all interactions.
• Monitor and manage claims turnaround times (TAT) to meet service level agreements.
• Identify and flag potential fraud indicators and refer to the appropriate department for further investigation.
• Provide feedback and insights on claim trends, rejection reasons, and process improvements.
• Manage claims-related costs by applying cost containment strategies, negotiating with service providers, and ensuring alignment with policy limits and guidelines.
• Limit financial leakages and losses through accurate claim assessments, settlements, and adherence to policy terms.
• Stay updated on product knowledge, policy changes, and industry regulations.