Insurance Claims Assessor is one of the professional occupations in the Insurance Sector where there is a scarcity of skills. The Insurance Claims Administrator (Insurance Claims Assessor) qualification will prepare a learner to operate as an Insurance Claims Administrator (Insurance Claims Assessor).

A qualified learner will be able to:
• Receive notification of a claim and investigate the validity thereof against the contract
• Assess a claim to determine the outcome of claims whether to settle or reject a claim
• Mitigate and finalise the claims process and provide comments on risk improvements and moral risks.

Qualifications

Occupational Certificate: Insurance Claims Administrator (Insurance Claims Assessor) (SAQA ID: 99668)

Target Market

New entrants and currently employed Administrators, Claims Negotiators, Claims Officers and Insurance Claims Assessors

Entry Requirements

NQF Level 4 qualification or 3 years work experience in the Insurance industry.

The following modules and outcomes form part of this qualification:
Knowledge Module (41 credits):
• Basics of insurance
• Claims handling procedures
• Professional Behaviour and Financial literacy

Practical Skills Module (40 credits):
• Receive a basic claim in order to assess the loss/ damage and verify the validity of the contract
• Assess the claim to determine validity
• Recommend to settle, conditionally settle or reject the claim
• Comment on risk improvements where applicable

Work Experience Module (50 credits – one of the following clusters):
• Verification processes regarding Statutory claims
• Assessment processes regarding Statutory claims
• Finalisation processes of Statutory claims

OR

• Receipt of notifications and verification processes regarding Long-term insurance
• Assessment process regarding Long-term insurance
• Decisions for payments to relevant stakeholders regarding Long-term insurance

OR

• Receipt of notifications and verification processes regarding Health Care
• Assessment processes regarding Health Care claim
• Decisions for payments to relevant stakeholders regarding Health Care claims

OR

• Verification processes regarding Short-term insurance
• Participation of assessment process regarding Short-term insurance
• Making recommendation regarding Short-term insurance

Integrated Formative Assessment:
Successful completion of the formative assessment leads to entrance into the integrated external summative
assessment.

Integrated Summative Assessment:
An external integrated summative assessment, conducted through INSETA as the Quality Council for Trades and Occupations (QCTO) Assessment Quality Partner, is required for the issuing of this qualification. The external integrated summative assessment (EISA) will focus on the exit level outcomes and associated assessment criteria. The external assessment will be conducted by means of written assessments conducted by registered assessors at accredited assessment centres over a period of not more than 3 hours.

Target Group

New entrants and currently employed Administrators, Claims Negotiators, Claims Officers and Insurance Claims Assessors