Insurance Claims Administrator (Insurance Claims Assessor)

The purpose of this qualification is to prepare a learner to operate as an Insurance Claims Administrator (Insurance Claims Assessor). An Insurance Claims Administrator (Insurance Claims Assessor) assesses the validity of the claim against the contract in order to determine or recommend whether to settle or reject a claim and provide comments on risk improvements and moral risks. A qualified learner will be able to: • Receive notification of a claim and investigate the validity thereof. • Assess a claim to determine the outcome of claims. • Mitigate and finalise the claims process.

According to the Insurance Sector Skills Plan (SSP), there are scarce skills identified within the industry. Whilst Insurance Claims Assessors were not explicitly named, it is one of the professional occupations in the sector where there is a scarcity of skills. This qualification is aimed at ensuring the development of qualified assessors to address this scarcity. Wide consultation with professional bodies such as the Insurance Institute of South Africa (IISA) and the Financial Planning Institute (FPI) was undertaken by the Insurance Sector Education and Training Authority (INSETA) prior to the development of the qualification. As a result, this Insurance Claims Assessor's occupational qualification in Short-term, Long-term, Health and Statutory insurance sectors was proposed. The qualification will provide knowledge and skills required by learners operating within the outlined sectors. It will also equip new entrants and those who are currently employed within the industry with knowledge and skills to competently function as Insurance Claims Assessors. Individuals operating in these sectors as Administrators, Claims Negotiators, Claims Officers and Insurance Claims Assessors will benefit from this qualification. This qualification will benefit individuals who have worked competently as Insurance Claims Assessors without formal education since they will have the acquired skills and knowledge recognised through the process of Recognition of Prior Learning (RPL). Qualified learners will have a competitive advantage to gain employment within the claims environment. The industry will benefit from the employment of qualified assessors who will perform their jobs effectively and thereby contribute efficiently to the economy.

Recognition of Prior Learning (RPL): RPL for access to the external integrated summative assessment: Accredited providers and approved workplaces must apply the internal assessment criteria specified in the related curriculum document to establish and confirm prior learning. Accredited providers and workplaces must confirm prior learning by issuing a statement of result or certifying a work experience record. RPL for access to the qualification: Accredited providers and approved workplaces may recognise prior learning against the relevant access requirements. Entry Requirements: NQF Level 4 qualification or 3 years work experience in the Insurance industry.

• Identify, analyse and verify the validity of claims in the relevant insurance context.
• Assess, calculate and complete claims in the relevant insurance context.
• Finalise claims in the relevant insurance context.