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Senior Claims Agent

  • On-site
    • Sandton, Gauteng, South Africa
  • Claims

Job description

ABOUT US:

The Senior Claims Agent at Pineapple Tech (Pty) Ltd is responsible for full-cycle ownership of motor insurance claims with a strong emphasis on compliance, accuracy, customer resolution, and risk awareness. This role involves validating and processing claims with deeper scrutiny, identifying red flags, and ensuring alignment with Pineapple’s SOPs, Treating Customers Fairly (TCF) principles, and risk mandates where applicable. Senior Claims Agents serve as quality drivers within the department and operate with a higher level of accountability, supporting continuous improvement and customer trust.

REQUIREMENT:

  • Degree or Diploma in Insurance, Risk Management, or related field

  •  Class of Business, RE5, FAIS 

  • 3-5  years in short-term insurance claims with exposure to fraud detection and client escalation handling, particularly within insurance or financial services

RESPONSIBILITIES:

  • Manage the full claims lifecycle from registration to final settlement.

  • Verify documents, apply policy terms, and ensure regulatory and internal compliance.

  • Identify discrepancies, red flags, and potential fraudulent claims.

  • Maintain turnaround times and service-level consistency.

  • Provide timely, empathetic, and professional communication with clients.

  • Maintain proactive follow-ups and ensure clear expectations throughout the claims process.

  • Resolve escalations promptly, ensuring client satisfaction and retention.

  • Ensure adherence to FAIS, TCF, and RE5 regulatory requirements in claims handling.

  • Maintain full audit readiness and data accuracy across all systems.

  • Support QA reviews and implement feedback effectively.

  • Escalate irregularities or potential misconduct appropriately. 

  • Collaborate across Claims, Finance, and Customer Service teams for seamless claim resolutions.

  • Support process enhancement and contribute to cross-functional problem-solving sessions.

  • Mentor Junior Claims Agents by providing guidance, training, and support on complex claims.

  • Foster teamwork and uphold Pineapple’s values through professional leadership conduct.

  • Engage in ongoing upskilling, compliance refresher courses, and performance reviews.

  • Contribute to innovation initiatives and share insights for process improvement.

  • Stay informed about industry trends, regulatory changes, and fraud patterns.

KNOWLEDGE:

  • End to end motor claims workflow

  • TCF & Fais principles

  • Fraud Indicators & identification

  • Service provider Process 

  • Red Flag identification

  • Customer complaint management

Pineapple Tech PTY LTD is an equal opportunity employer. We welcome and encourage applications from individuals of all backgrounds and experiences.

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