Job Description

Closing Date 2025/06/28
Reference Number MMH250611-7
Job Title Gap Claims Assessor (Zestlife)
Position Type Permanent
Role Family Client Services
Cluster Guardrisk
Remote Opportunity Some of the time
Location - Country South Africa
Location - Province Western Cape
Location - Town / City Claremont, Cape Town
Introduction
Are you ready to take on a vital role where your attention to detail, communication skills, and commitment to excellence make a real difference? We are looking for a dedicated GAP Claims Assessor to join our fast-paced insurance environment and play a key part in delivering outstanding service to our clients.
In this role, you will be at the heart of the claims process--validating documents, assessing claims, and ensuring that every client's expectations are managed professionally and efficiently. If you have solid experience with medical aid claims processing, a strong understanding of insurance policies, and a passion for helping clients through every step of their claim, we want to hear from you!
Please note, this position is based in Claremont, Cape Town, and the company will not consider candidates requiring relocation.
This is your opportunity to thrive in a role where your skills in negotiation, time management, and client communication are valued--and where you can contribute to improving the claims journey for all stakeholders.
Disclaimer As an applicant, please verify the legitimacy of this job advert on our company career page.
Role Purpose

• Claims administrative responsibilities in respect of GAP Short Term Insurance Products.
• Ensuring that the principles and outcomes of TCF (Treating Customers Fairly) are practiced and achieved in all duties performed and services provided to Zestlife customers.

Requirements

• 2-3 Years experience within a medical claims assessing role
• Matric Qualification
• Good understanding of how medical aids work and operate
• Willingness to always assist clients with their claims and requirements
• Kindly note that only applicants with the following relevant experience will be considered for interview:
• Actual Medical Aid claims processing and administration experience
• Insurance industry experience

Duties & Responsibilities
The duties for which you will be responsible in terms of this contract are briefly listed below and will be subject to amendment from time to time as required based on discussions with your manager:

• To check and validate all GAP claim documents received and to request any outstanding documents
• To follow the claims process and capture the claim information onto the system
• To verify and update any client personal information changes on the system policy record
• To assess the validity of the claim in accordance with the terms and conditions of the clients policy document and to make the relevant claim notes on the system
• To ensure a clients claim expectation is adequately addressed and managed by applying the TCF principals and effectively communicating with the client or broker regarding their claim
• To meet your daily minimum claim targets with a high level of accuracy and within service turnaround time
• To maintain and update your daily workflow tasks and queue
• To ensure high-priority and escalated claims, as identified by management, are processed within 2 hours
• Interacting with medical aids, hospitals, and medical practitioners regarding medical history and accounts required to assess the claim.
• Other administration-related functions

Competencies

• Ability to apply administration principles and work with detail and a high level of accuracy
• Intermediary MS Office skills, especially Excel, Word and Microsoft Outlook
• Good time management
• Planning and organising
• Works well in a team and independently
• Coping with pressure and setbacks
• Being pro-active and using your initiative
• Ability to work well under pressure
• Commitment to meet daily targets
• Self-motivated
• Having a can-do attitude

Policy
We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.