Claims Specialist

Under the supervision of the Chief Operations Officer (Insurance), the following are among the key responsibilities:

· Receive, acknowledge, register and classify claims promptly, and maintain a complete, accurate and current claims register.

· Review policy schedules, wording, endorsements, premium status and applicable terms to confirm cover and identify documentation requirements.

· Guide clients on claim procedures, required evidence, applicable timelines and their responsibilities throughout the claims process.

· Notify insurers within agreed timelines and submit complete claims documentation for assessment.

· Coordinate with insurers, loss adjusters, assessors, repairers, medical providers, legal advisers and other service providers to progress claims.

· Monitor outstanding requirements, reserves, offers, discharge documentation and settlement payments, and follow up proactively to prevent avoidable delays.

· Validate settlement offers against policy terms and supporting documents, explain outcomes to clients and facilitate completion of settlement formalities.

· Maintain orderly electronic and physical claim files with a clear audit trail of communications, documents, decisions and approvals.

· Provide clients and internal stakeholders with regular, accurate and professional status updates from notification to closure, and resolve or appropriately escalate claims-related queries and complaints.

· Identify complex, high-value, suspected fraudulent, repudiated or disputed claims and escalate them to the Chief Operations Officer.

· Ensure claims are handled in accordance with applicable insurance laws, regulatory requirements, data-protection obligations, internal controls and approved procedures.

· Monitor service-level agreements, ageing, repudiations, recoveries, outstanding documentation and settlement turnaround times.

· Prepare accurate daily, weekly, monthly and ad hoc claims reports, dashboards and portfolio analyses for management decision-making.

· Support audit, compliance and regulatory reviews by providing complete records and implementing agreed corrective actions.

· Identify recurring loss trends, control weaknesses and process gaps, and recommend preventive actions and service improvements.

· Uphold the highest standards of ethics, integrity and professional conduct by complying with the organisation’s Code of Conduct, declaring conflicts of interest, safeguarding confidential information and reporting suspected misconduct or unethical behaviour through approved channels.

· Work closely with operations, broking, sales, finance, compliance and client-service teams to ensure seamless claims support and consistent claims-handling practices.

· Perform any other responsibilities or tasks assigned by management.

INTERNAL/EXTERNAL CONTACT

· External: Clients, insurance companies, reinsurers, loss adjusters, assessors, repairers, medical providers, legal advisers and other claims service providers.

· Internal: Chief Operations Officer, broking and sales teams, Operations, Finance, Risk, Compliance, Legal, IT and relevant Zanaco stakeholders.

QUALIFICATIONS/EXPERIENCE

· Grade 12 Certificate or equivalent, with credits in Mathematics and English.

· Bachelor’s degree in Insurance, Risk Management, Business Administration, Finance, Economics, Commerce or a related field.

· A relevant insurance qualification from a recognised professional body will be an added advantage.

· At least six (6) years’ relevant experience in insurance claims, insurance broking, underwriting, loss adjusting or a regulated financial-services environment.

· Strong practical knowledge of claims processes, policy interpretation, documentation, insurer liaison and settlement follow-up.

· Experience in claims reporting, service-level monitoring and handling client complaints or disputed claims.

· Proficiency in Microsoft Excel, Word, Outlook and relevant insurance or business systems.

JOB CORE COMPETENCIES

· Claims administration and policy interpretation

· Client service and stakeholder management

· Analytical thinking and problem solving

· Negotiation and resolution management

· Risk, compliance and control awareness

· Attention to detail and records management

· Planning, prioritisation and follow-through

· Data analysis and management reporting

· Professional written and verbal communication

· Integrity, confidentiality and accountability

· Teamwork and continuous improvement