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Cape Town, Western Cape, South Africa
Onsite
As a Claims Agent, you will play a vital role in supporting the delivery of high-quality service and operational excellence across our many schemes, brands and products. Focused on Claims processing and assessment, you will work under the guidance of the Team Leader to carry out tasks with accuracy, effectiveness and efficiency. For more senior roles, you will be making claims decisions, in line with policy, regulatory requirements and assigned accountabilities.
Your role will be assigned to either be the point of contact for our customers, often front line, delivering exceptional service across multiple communication channels including phone, email, and digital platforms. You will play a key role in ensuring a seamless customer experience by resolving queries efficiently, accurately, and with empathy. Alternatively, your role may be assigned to be part of the claims processing teams, offline, performing critical work to ensure effective operational processing, or in some cases may be a combination of these roles.
In all cases, you will work collaboratively within a team focused on high performance and strong execution effectiveness to meet service level agreements (SLAs), KPIs and targets as assigned, and contribute to continuous improvement initiatives, upholding the company’s values in every interaction and action.
Above all, you will help deliver fair and consistent claim outcomes through clear, principle-led communication, whether over the phone or in writing, delivering productively to company targets.
• Handle inbound and outbound customer interactions across voice, email, and digital channels as assigned.
• Resolve customer queries and complaints effectively, ensuring high quality first-contact resolution where possible.
• Deliver claim outcomes through clear, professional, effective and empathetic conversations, guided by principles (or scripts dependant on local law). In all cases the quality and “tone of voice”, whether in writing or over the phone, must meet or exceed the standards set out.
• Accurately log and update customer interactions and all operational tasks in the company systems.
• Follow standard operating procedures and adhere to regulatory and compliance requirements.
• Complete assigned tasks within agreed timeframes and quality standards.
• Follow work allocation plans and prioritise tasks effectively, understanding customer and business needs.
• Meet or exceed individual performance targets including quality, productivity, and customer satisfaction.
• Participate in regular coaching, training, and team meetings to support personal and team development.
• Contribute to a positive, inclusive, and collaborative team environment.
• Identify, contribute to and/or suggest opportunities for process improvements or service enhancements.
• Review and process claims in accordance with the policy wording and as defined by the Insurer, based on your agreed authority levels and duties assigned.
• Where a claim is admissible or declined ensure that a detailed explanation is given and to follow this in writing where requested.
• Accurately assess all claims and respond to claimant with concise communications detailing all further information/documentation required to proceed with claim or giving full explanation of claim outcome, effectively describing the settlement or reasons for decline.
• Ensure all recovery aspects of claims are identified, monitored and amounts due are obtained where appropriate.
• To accurately prepare, assess and where needed, input claims documentation related to payments to either clients or third-party suppliers, into the company systems.
• Ensure any potential fraud indicators are identified and acted upon.
• Maintain accurate records and documentation in line with regulatory and procedural requirements.
• Support the team in achieving performance targets and service level agreements.
• Invoke escalation and referral procedures and routes where required including but not limited to; Team Leaders, Fraud Specialists, Complaint teams or Operational Support.
• Support the ongoing productivity of the team and organisation, picking up other operational activities associated with the processing of claims as assigned.
• Participate in regular performance discussions and feedback sessions.
• Collaborate with colleagues to ensure smooth workflow and knowledge sharing.
• Maintain a customer-focused approach in all activities, ensuring service excellence.
• Adhere to company policies, procedures, and regulatory requirements always.
• Experience in a customer-facing role, preferably in a contact centre or operational service environment or claims operations organisation. This may include experience in a back-office or administrative role for back-office roles; however a strong customer servicing ethos is essential.
• Strong communication skills, both verbal and written.
• Ability to remain calm and professional under pressure.
• Proficient in using the company systems (or similar external experience) and Microsoft Office tools.
• Strong attention to detail and commitment to accuracy.
• A proactive, solution-focused mindset with a passion for delivering excellent service.
• Strong attention to detail and commitment to accuracy.
• Ability to manage your time effectively and prioritise workload to meet productivity, quality and other targets as agreed from time-to-time necessary to perform your duties assigned.
• Focused on working to, meeting and exceeding performance metrics and targets.
• Willingness to learn and adapt in a dynamic environment.
• Team-oriented mindset with a proactive approach to problem-solving.
• Understanding of regulatory requirements and quality standards (training provided).
Communication | High | Communicates clearly and professionally with customers, colleagues and stakeholders
Client Service | High | Delivers outstanding service and builds positive customer and client relationships (internal and external)
Team Working | Intermediate | Collaborates effectively and supports team goals.
Results Focused | Intermediate | Meets performance targets and deadlines consistently, including completing tasks efficiently.
Innovation & Continuous Improvement | Basic | Suggests improvements and embraces change.
Problem Solving | Intermediate | Resolves issues efficiently and escalates when appropriate.
Resilience | Intermediate | Maintains performance and positivity under pressure.
Performance Management | Intermediate | Works towards individual goals and contributes to team success.
• Adhere to relevant regulatory Conduct Rules and the Firm’s Code of Conduct, including but not limited to the Financial Conduct Authority and Central Bank of Ireland.
• Undertake all regulatory training as prescribed by the company and comply with all policies relevant to your role.
• Immediately report any known conflicts of interest in line with company policy.
• Meet, on an ongoing basis, the company’s fit and proper requirements which, as a minimum, shall take account of your: ○ Honesty, integrity and reputation
○ Competence and capability; and
○ Financial soundness
• Hold valid certificates/accreditations certifying that you are a fit and proper person to perform the regulated function to which the certificate relates, e.g. APA qualification.
• Carry out the role with honesty and integrity in the best interests of the Firm and its customers.
• Maintain a Duty of Responsibility for all activities managed within the role.
We want our people to feel recognised, supported and able to thrive both at work and beyond it.
We offer a competitive reward package designed to support your financial, physical and mental wellbeing, alongside opportunities to learn, develop and be recognised for the contribution you make. Benefits vary by role and location, and full details will be shared as part of the application process.
Collinson Group is an equal opportunities employer. We welcome applications from people of all backgrounds, identities and experiences, and believe that different perspectives make our business stronger.
