Occupational Certificate: Insurance Claims Administrator NQF 4
Step into the insurance industry with confidence through our NQF Level 4 Insurance Claims Administrator course. To start, you’ll gain a clear understanding of insurance principles and the claims lifecycle. This includes learning how to assess claims. It also includes processing documentation and applying relevant legislation. Additionally, you’ll explore customer service techniques and regulatory compliance. From day one, you’ll develop the foundation needed to work efficiently in claims environments. As a result, your industry readiness will grow rapidly.
Next, you will enhance your administrative and communication skills. You will also develop attention to detail and accuracy in documentation. Moreover, you’ll learn how to handle disputes and provide professional support to clients. After that, you will strengthen your organisational skills. You’ll also gain time management techniques. In the same manner, the course builds your ability to resolve problems. These skills are essential in insurance environments. By the same token, they’ll help you work effectively in team settings. Meanwhile, your confidence and efficiency will increase.
Furthermore, this qualification boosts your ability to support claims departments. It also ensures you understand key legislation, such as FAIS and the Short-Term Insurance Act. Besides that, it empowers you to assist with claim assessments and customer queries. In fact, you’ll be equipped to contribute to client satisfaction and operational success. As a result, you’ll be prepared for careers in insurance companies, brokerages, or third-party administrators. Because of this, your career opportunities will broaden. In other words, your skills will be recognised and valued.
In the same way, you’ll be ready to take on new responsibilities. You’ll grow professionally and personally. What’s more, you’ll handle complex claims with clarity. Likewise, your industry knowledge will deepen. Not only that, you’ll become adaptable in fast-paced work environments. At the same time, your ability to make decisions under pressure will improve.
About Qualification
The Occupational Certificate: Insurance Claims Administrator is a nationally recognised NQF Level 4 qualification designed to prepare learners for the assessment and administration of insurance claims.
Learners are equipped to work across statutory, healthcare, long-term, and short-term insurance sectors, developing the knowledge, practical skills, and workplace experience needed to operate confidently, ethically, and compliantly in South Africa’s financial services industry.
What You Will Gain From This Course
- Learn how claims are initiated, assessed, processed, and finalised within industry standards and regulatory frameworks.
- Improve your ability to capture, verify, and manage claims data with precision and professionalism.
- Develop effective written and verbal communication techniques for interacting with clients, colleagues, and stakeholders.
- Learn how to provide support and resolve customer queries while maintaining empathy and professionalism.
- Build your ability to assess claims objectively and resolve common issues that arise during the claims process.
- Master time management, task prioritisation, and workflow organisation to thrive in high-volume environments.
Purpose
This qualification prepares learners to function as Insurance Claims Administrators (Occupational Code 431204) who can:
- Receive, review, and verify insurance claims
- Assess claims validity and quantify compensation
- Recommend settlements, conditional settlements, or rejections
- Apply legal and regulatory standards (FAIS, POPIA, TCF, PPR)
- Communicate effectively with policyholders, insurers, service providers, and legal teams
- Identify risks, suggest improvements, and detect potential fraud
Course Content
- Overview of the insurance industry
- Role players, regulatory environment, legal principles, insurance fundamentals
- Claims lifecycle, documentation, verification, contract rules, prescription periods, complaints handling
- Business communication, customer service, negotiation, conflict resolution, basic financial calculations
- Receive and validate claim notifications
- Assess claims and determine outcomes
- Recommend settlements, conditional settlements, or rejections
- Provide feedback on risk improvements and fraud prevention
- Practical exposure in statutory, health, long-term, and short-term insurance
- Tasks include claim verification, assessment, documentation, decision-making, and reporting
- Workplace logbook completed under mentor supervision
Part Qualifications
This Occupational Certificate can be registered in 4-part qualifications.
Part Qualification 1:
Title: Statutory Insurance Claims Assessor, NQF Level 04, Credits 131
Purpose: Statutory Insurance Claims Assessor assesses the validity of the claim against the legislation in order to determine or recommend whether to settle or repudiate a claim.
Part Qualification 2:
Title: Long-term Insurance Claims Assessor, NQF Level 04, Credits 131
Purpose: Long-term 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.
Part Qualification 3:
Title: Health Insurance Claims Assessor, NQF Level 04, Credits 131
Purpose: Health Insurance Claims Assessor assesses the validity of the claim against the contract in order to determine/ recommend whether to settle or reject a claim.
Part Qualification 4:
Title: Short-term Insurance Claims Assessor, NQF Level 04, Credits 131
Purpose: Short-term 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.
Delivery
The programme uses a blended learning approach:
- Online (distance) learning for knowledge modules, with virtual support sessions
- Face-to-face practical facilitation for hands-on skills training
- Workplace-based learning at an approved insurance employer, including real-world application and logbook completion
Entry Level Requirements
Learners must have:
- A National Senior Certificate (Grade 12, NQF Level 4), OR
- At least 3 years of verified insurance work experience
Additional:
- Access to a registered workplace for practical experience
- Basic computer literacy and communication skills
Recognition of Prior Learning (RPL) can be applied where relevant.
Possible Careers on Completion
Qualifying learners could follow a career in:
– Business Analyst
– System Tester
– System Implementation
Accreditation
- Qualification Title: Occupational Certificate: Insurance Claims Administrator
- SAQA Qualification ID: 99668
- NQF Level: 4
- Total Credits: 131
- Registration Authority: Quality Council for Trades and Occupations (QCTO)
- Primary SETA: Insurance Sector Education and Training Authority (INSETA)
- Field: Business, Commerce and Management Studies
- Minimum Duration: 12 Months (full-time)