Claims Assessor: Pet

The Pet Claims Administrator & Repudiation Support is responsible for providing administrative support to the Pet Claims Department, with a primary focus on claim administration, repudiation processing, customer communication, quality assurance, and operational support.

This role ensures that repudiated claims are processed accurately, professionally, and in accordance with policy wording, internal procedures, and regulatory requirements while maintaining excellent customer service standards.

Key Responsibilities

Claims Administration

•Receive and process incoming claims documentation.

•Verify claim information for completeness and accuracy.

•Allocate and track claims through the claim’s workflow.

•Maintain accurate records within the claims management system.

•Assist assessors with administrative functions during claim assessments.

•Prepare claim files for review and audit purposes.

•Ensure all required documentation is uploaded and filed correctly.

Repudiation Support

•Prepare repudiation letters using approved templates.

•Ensure repudiation reasons accurately reflect policy wording and assessment outcomes.

•Verify that all repudiations contain supporting documentation before being issued.

•Attach relevant policy wording and supporting documents to client communications.

•Ensure complaints resolution information accompanies repudiation correspondence where required.

•Escalate unclear or complex repudiations to senior assessors or management.

•Track repudiated claims and maintain accurate reporting.

Customer Communication

•Communicate professionally with clients, veterinary practices, brokers, and internal stakeholders.

•Respond to general claim and repudiation queries.

•Request outstanding documentation from clients or veterinary practices.

•Maintain empathy and professionalism during difficult customer interactions.

•Ensure correspondence is clear, accurate, and aligned with Oneplan standards.

Operational Support

•Monitor assessor queues and assist with workload administration.

•Assist with claim status updates.

•Maintain turnaround time targets.

•Assist with operational reporting.

•Participate in departmental projects and process improvements.

Quality Assurance

•Review outgoing repudiation correspondence for

oGrammar and spelling

oCorrect policy references

oAccurate benefit application

oSupporting documentation

oProfessional communication

•Identify trends and recurring repudiation reasons.

•Assist in maintaining standard operating procedures (SOPs).

•Report process improvement opportunities.

Compliance

•Ensure all work complies with

oOneplan Policy Wordings

oInternal Claims SOPs

oFAIS requirements

oPOPIA

oTreating Customers Fairly (TCF) principles

•Maintain confidentiality of all customer information.

•Ensure accurate audit trails for every claim.

Minimum Requirements

Education

•Grade 12 (Matric) – Essential.

•Certificate or Diploma in Administration, Insurance, or Veterinary Nursing (Advantageous).

Experience

•Minimum 1 years' administrative experience.

•Claims administration experience preferred.

•Insurance industry experience advantageous.

•Customer service experience essential.

Knowledge

•General insurance principles.

•Claims administration processes.

•Customer service principles.

•Microsoft Office (Excel, Word, Outlook, Teams).

•Basic understanding of veterinary terminology (advantageous).

•Document management systems.

Skills

•Excellent written communication.

•Strong administrative ability.

•Attention to detail.

•Time management.

•Organisation and planning.

•Problem-solving.

•Professional telephone etiquette.

•Ability to prioritise workloads.

•Strong interpersonal skills.

•Accurate data capturing.

•Ability to work under pressure.

•Team collaboration.

Competencies

•High level of integrity.

•Accountability.

•Customer-focused.

•Adaptability.

•Emotional resilience.

•Initiative.

•Quality orientated.

•Confidentiality.

•Continuous improvement mindset.

•Professionalism.