Senior Claims AdministratorAmbledown Financial Services • Johannesburg, Gauteng, South Africa

Senior Claims Administrator

Ambledown Financial Services • Johannesburg, Gauteng, South Africa

3 days ago

Job description

We are seeking aSenior Claims Administratorwith strong clinical background to join our team.

Qualifications

Clinical or Nursing Diploma / Degree.
SANC Registered.
FAIS Compliant (advantageous).

Skills and Experience

At least 2 – 3 years' gap cover claims experience.

Technical knowledge of various health insurance products.

Advanced knowledge of ICD Codes, medical procedures, and medical aid schemes.

Sound understanding of Prescribed Minimum Benefits (PMB) legislation in conjunction with gap cover.

Experience in dealing with escalated and / or complex claims.

Strong computer skills, including Microsoft Office and intermediate to advanced Excel.

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.

Ability to work independently and as part of a team.

Ability to prioritise tasks effectively in a fast-paced environment.

Strong organisational and time management skills.

Sound ethical judgment and integrity, ensuring compliance with internal policies and regulatory standards.

Demonstrate continuous learning mindset with a willingness to stay current on clinical advancements and industry changes.

Reporting To

Claims Supervisor

Scope of Responsibility

Authorise assessed 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.

Applications

#J-

Ljbffr

#J-18808-Ljbffr

Create a job alert for this search

Senior Administrator • Johannesburg, Gauteng, South Africa

Related jobs

Warranty Administrator

Henred Fruehauf • Germiston, South Africa

Manage warranty process of submitting, tracking and resolving warranty claims;.Maintain records of warranty claims and relevant documentation. .Ensure accurate documentation and compliance with manu...Show more

Last updated: 30+ days ago • Promoted

Payroll Administrator

Boardroom Appointments • Springs, South Africa

Diploma / NQF 6 (Diploma in Finance with Payroll experience required).Sage Payroll Academy certification (advantageous).Minimum 3-4 years related experience and / or training.Knowledge of relevant la...Show more

Last updated: 30+ days ago • Promoted

Sales Administrator

ICT Engage • roodepoort, Gauteng, South Africa

We are looking for a proactive, organised and customer-focused individual to act as a key support link between our client's Sales team, operations and senior management. In this dual-capacity role y...Show more

Last updated: 22 days ago • Promoted

Creditors Administrator

HR Genie • Nigel, South Africa

A career opportunity exists at.REINHARDT TRANSPORT NIGEL HEAD OFFICE.Capture creditor invoices in accordance with set guidelines. Ensure that all creditor invoices are approved / signed off by releva...Show more

Last updated: 30+ days ago • Promoted

Key Accounts & Claims Administrator

Green Marble Recruitment Consultants • Johannesburg, South Africa

Insurance qualification (RE5, NQF Level 4 or higher preferred).Solid and proven key account management experience (essential). Strong customer relations background, ideally within insurance, banking...Show more

Last updated: 1 day ago • Promoted

Senior Systems Administrator

Network Recruitment • Centurion, South Africa

Ensure that adequate IT cybersecurity and information security controls are implemented and maintained.Maintain an IT infrastructure capable of supporting the organisations operational and strategi...Show more

Last updated: 6 days ago • Promoted

Senior Stores Administrator

Dante Personnel • Centurion, South Africa

Previous warehouse / storeman experience is needed.Strong organisational and time-management skills.Ability to work well under pressure and meet deadlines.Show more

Last updated: 8 hours ago • Promoted • New!

Aftersales Administrator

Edge Executives • Centurion, South Africa

Aftersales Administrator – Farm | South Africa | Permanent.Help keep tractors working and dealers informed.If you thrive on precision, pace, and proactive communication, this role will fit like a g...Show more

Last updated: 19 days ago • Promoted

Claims Administrator - Centurion

PRR Recruitment • Centurion, South Africa

PERSONAL LINES CLAIMS ADMINISTRATOR – CENTURION.If you're an administrative maestro with a passion for insurance, we've got the perfect role waiting for you. Step into a high-impact position where y...Show more

Last updated: 30+ days ago • Promoted

Loss Adjusting Manager

The Recruitment Council • sandton, Gauteng, South Africa

Lead as a Loss Adjusting Manager Sandton or Cape Town.A leading insurer is looking for an experienced.This is an excellent opportunity for a strategic leader with a strong background in constructi...Show more

Last updated: 30+ days ago • Promoted

Life Claims Assessor

Isilumko Staffing (JHB) • Johannesburg, South Africa

To ensure claims are assessed accurately and communicated effectively, in line with business rules and service level agreements. Assess an average of 7 benefits per day.Communicate formally and prof...Show more

Last updated: 30+ days ago • Promoted

Claims Assessor : Life / Death / Disability / Severe illness - 6 month contract

Isilumko Staffing (JHB) • Johannesburg, South Africa

Position : Claims Assessor – Individual Life Benefits.Industry : Long-Term Insurance | Banking Client.Are you a detail-oriented professional with a passion for precision, service excellence, and impa...Show more

Last updated: 30+ days ago • Promoted

Claims Administrator - Funeral

Affinity Health • Johannesburg, South Africa

Process, and Capture, Claims Information.Respond to members / claimants and request all required documents.Validate policy status, nominated dependants and beneficiaries. Confirm policy terms and cond...Show more

Last updated: 30+ days ago • Promoted

Underwriting Administrator

One Spark • Sandton, South Africa

The Underwriting Admin plays a critical role in supporting Dis-Chem Life’s underwriting team to deliver seamless, accurate, and client-focused service. This role ensures that insurance applications ...Show more

Last updated: 4 days ago • Promoted

Insurance : Claims Consultant

Emporium Human Capital • Roodepoort, South Africa

Insurance : Claims Consultant - POS25208.R160,000 and R200,000 CTC + Performance based bonus.This role involves managing the full claims process for short-term insurance clients, ensuring accuracy, ...Show more

Last updated: 30+ days ago • Promoted

Sales Administrator

IOCO • Midrand, South Africa

We are seeking a dependable and detail-oriented Sales Administrator to provide support in delivering the complete AVEVA software portfolio across South Africa and Southern Africa.The role focuses o...Show more

Last updated: 30+ days ago • Promoted

Mine Technical Manager ( Spare Part / Sales (Vibrating),

Rakkgalakane • Krugersdorp, South Africa

Mine Technical Manager ( Spare Part / Sales (Vibrating), West Rand, Rneg.Technical screening equipment and components.Spares and Services Department. Costing, quoting and processing of customer spare ...Show more

Last updated: 30+ days ago • Promoted

Creditors Administrator

Reinhardt Transport • Nigel, Ekurhuleni Metro, South Africa

Quick Apply

A career opportunity exists at.REINHARDT TRANSPORT – NIGEL HEAD OFFICE.Capture creditor invoices in accordance with set guidelines. Ensure that all creditor invoices are approved / signed off by...Show more

Last updated: 30+ days ago