NQF Level 4 | INSETA

Insurance Claims Administrator/Assessor

Become an expert in insurance claims administration and assessment with comprehensive training in claims handling, procedures, and specialized claims processing across multiple insurance sectors.

131
Credits
30
Months
NQF 4
Level
Insurance claims administrator reviewing claim documents

Qualification Overview

This Insurance Claims Administrator/Assessor qualification provides comprehensive training in claims handling procedures, assessment techniques, and specialized claims processing. The program covers long-term, short-term, statutory, and health care claims with practical skills needed for professional claims administration.

Learning Outcomes

Upon completion of this qualification, learners will be able to:

  • Apply basic insurance principles and concepts
  • Demonstrate professional behavior and financial literacy
  • Implement claims handling procedures effectively
  • Process claims using established procedures and systems
  • Specialize in specific claims types (long-term, short-term, statutory, or health care)
  • Assess claims validity and determine appropriate settlements

Career Opportunities

This qualification opens doors to claims administration roles including:

Claims Administrator
Claims Assessor
Claims Manager
Insurance Investigator
Claims Specialist
Loss Adjuster

Core Modules

Module 1: Basics of Insurance

  • • Basics of insurance
  • • Insurance contract law and terminology
  • • Types of insurance products and coverage
  • • Regulatory framework and compliance
  • • Risk management and assessment basics

Module 2: Professional Behaviour

  • • Professional ethics and conduct standards
  • • Financial literacy for insurance professionals
  • • Customer service excellence
  • • Communication skills and best practices

Module 3: Claims Handling Procedures

  • • Standardized claims handling protocols
  • • Documentation and record-keeping requirements
  • • Initial claim assessment techniques
  • • Regulatory compliance in claims processing

Module 4: Claims Processing

  • • Comprehensive claims workflow management
  • • Investigation techniques and evidence gathering
  • • Settlement calculations and negotiations
  • • Technology systems and digital processing
  • • Quality control and audit procedures

Module 5: Specialized Claims

  • • Choose one specialization area:
  • • Long-term Insurance Claims - life, disability, annuities
  • • Short-term Insurance Claims - motor, property, liability
  • • Statutory Claims - workers compensation, road accident fund
  • • Health Care Claims - medical schemes and benefits

Module 6: Claims Assessment

  • • Damage assessment and valuation methods
  • • Fraud detection and prevention
  • • Legal considerations and liability determination
  • • Settlement authority and escalation procedures
  • • Dispute resolution and claims appeals

Module 7: Statutory claims

  • • Verification processes regarding Statutory claims
  • • Assessment processes regarding Statutory claims
  • • Finalisation processes of Statutory claims

Module 8: Health Care Claims

  • • Assessment processes regarding Health Care claim,
  • • Receipt of notifications and verification processes regarding Health Care
  • • Decisions for payments to relevant stakeholders regarding Health Care claims

Qualification Details

SETA INSETA
NQF Level Level 4
Credits 131 Credits
Duration 30 Months
Delivery Mode Blended Learning
Assessment Competency Based
NLRD ID 99668
Status Accredited
Provider SpecCon

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