Overview
Claims Assessor – Pet Insurance Jobs in Sandton, Gauteng, South Africa at Oneplan.co.za
Title: Claims Assessor – Pet Insurance
Company: Oneplan.co.za
Location: Sandton, Gauteng, South Africa
Claims Assessor – Pet Insurance
Oneplan Pet Insurance
Location: Johannesburg, Gauteng
Department: Claims
Reporting to: Claims Manager
About Oneplan
Oneplan Pet Insurance is one of South Africa's leading pet insurance providers, helping pet owners access quality veterinary care while protecting them from unexpected veterinary expenses. We are looking for a detail-oriented and customer-focused Claims Assessor to join our growing Pet Insurance team
Purpose of the Role
The Claims Assessor is responsible for assessing, validating, and processing pet insurance claims in accordance with policy terms, underwriting rules, and claims protocols. The role requires strong analytical skills, attention to detail, and the ability to deliver exceptional customer service while ensuring fair and accurate claim outcomes.The successful candidate will work closely with policyholders, veterinary practices, and internal stakeholders to facilitate efficient claims processing and positive customer experience
Key Responsibilities
Claims Assessment
- Assess pet insurance claims in accordance with policy wording and benefit structures.
- Review veterinary invoices, treatment records, and supporting documentation.
- Verify claim eligibility, waiting periods, exclusions, and benefit limits.
- Ensure accurate and consistent claims decisions.
Claims Investigation & Validation
- Investigate complex or potentially fraudulent claims.
- Identify inconsistencies and request additional supporting information where required.
- Escalate suspicious or high-risk claims for further review.
- Apply underwriting and policy rules when assessing claims.
Customer & Veterinary Practice Support
- Communicate claims outcomes clearly and professionally.
- Liaise with veterinary practices regarding claim information and treatment details.
- Assist policyholders with claims queries and benefit explanations.
- Manage claims-related communications via telephone, email, and digital channels.
Administration & Compliance
- Maintain accurate claim records and audit trails.
- Ensure adherence to company policies and regulatory requirements.
- Meet claims turnaround times and service level agreements.
- Participate in quality assurance and audit processes.
Continuous Improvement
- Identify trends and recurring claims issues.
- Contribute to process improvement initiatives.
- Assist with updating claims procedures and guidelines.
Minimum Requirements
Qualifications
- Grade 12 / Matric
- Relevant qualification in Veterinary Nursing, Animal Health, Insurance, or related field advantageous
- RE5 qualification advantageous
Experience
- Minimum 2 years experience in:
- Insurance claims assessment
- Pet insurance claims
- Veterinary administration
- Veterinary nursing
- Medical claims administration
- Short-term insurance claims
Knowledge
- Pet Insurance products and policy structures
- Veterinary terminology and procedures (advantageous)
- Claims assessment processes
- Fraud detection principles
- Customer service best practices
Skills & Competencies
- Strong analytical and investigative skills
- Excellent attention to detail
- Customer-focused approach
- Sound decision-making ability
- Strong verbal and written communication skills
- Ability to work under pressure
- Problem-solving mindset
- High ethical standards
- Computer literacy and system navigation
Key Performance Indicators (KPIs)
- Claims Turnaround Time (TAT)
- Claims Accuracy Rate
- Productivity Targets
- Quality Assurance Scores
- Customer Satisfaction Scores
- Compliance Scores
- Fraud Detection & Escalation Effectiveness
Why Join Oneplan?
- Join one of South Africa's fastest-growing pet insurance providers.
- Work in a purpose-driven environment helping pets receive quality healthcare.
- Career growth and development opportunities.
- Dynamic and supportive team culture.
- Competitive remuneration and benefits.
Due to the high volume of applications received, only shortlisted candidates will be contacted. If you have not received a response within 4 weeks of submitting your application, please consider your application unsuccessful. We encourage you to apply for future opportunities with Oneplan that align with your skills and experience.
