SAQA ID: 99668
OC: Insurance Claims Administrator (Assessor)
Title of Qualification:
SAQA ID: 99668 OC: Insurance Claims Administrator (Assessor)
Duration of Qualification:
This programme consists of Core; Fundamental and Elective Unit Standards as follows and will be covered over a period of one year
Total Number of Credits: 131
Entry Requirements
NQF Level 4 qualification or 3 years work experience in the Insurance industry.
Knowledge Modules:
- 431204001-KM-01, Basics of insurance, Level 4, 17 Credits.
- 431204001-KM-02, Claims handling procedures, Level 4, 11 Credits.
- 431204001-KM-03, Professional Behaviour and Financial literacy, Level 4, 13 Credits.
Total number of credits for Knowledge Modules: 40.
Practical Skill Modules:
- 431204001-PM-01, Receive a basic claim in order to assess the loss/ damage and verify the validity of the contract, Level 4, 20 Credits.
- 431204001-PM-02, Assess the claim to determine validity, Level 4, 10 Credits.
- 431204001-PM-03, Recommend to settle, conditionally settle or reject the claim, Level 4, 5 Credits.
- 431204001-PM-04, Comment on risk improvements where applicable, Level 4, 5 Credits.
Total number of credits for Practical Skill Modules: 40.
Experience Modules:
- 431204001-WM-01, Verification processes regarding Statutory claims, Level 4, 10 Credits.
- 431204001-WM-05, Assessment processes regarding Statutory claims, Level 4, 15 Credits.
- 431204001-WM-09, Finalisation processes of Statutory claims, Level 4, 25 Credits.
Or - 431204001-WM-03, Receipt of notifications and verification processes regarding Long-term insurance, Level 4, 15 Credits.
- 431204001-WM-07, Assessment process regarding Long-term insurance, Level 4, 20 Credits.
- 431204001-WM-11, Decisions for payments to relevant stakeholders regarding Long-term insurance, Level 4, 15 Credits.
Or - 431204001-WM-02, Receipt of notifications and verification processes regarding Health Care, Level 4, 20 Credits.
- 431204001-WM-06, Assessment processes regarding Health Care claim, Level 4, 25 Credits.
- 431204001-WM-10, Decisions for payments to relevant stakeholders regarding Health Care claims, Level 4, 5 Credits.
Or - 431204001-WM-04, Verification processes regarding Short-term insurance, Level 4, Credits 15.
- 431204001-WM-08, Participation of assessment process regarding Short-term insurance, Level 4, 25 Credits.
- 431204001-WM-12, Making recommendation regarding Short-term insurance, Level 4, 10 Credits.
Total number of credits for Work Experience Modules is 50 credits per relevant insurance sector.
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.
