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INSETA Qualifications

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 specialised claims processing across multiple insurance sectors.

131

Credits

Months

NQF 4

Level

Insurance claims administrator reviewing claim documents

Qualification Overview

The Insurance Claims Administrator NQF Level 4 qualification is designed to prepare learners to operate as an Insurance Claims Administrator (Insurance Claims Assessor). This qualification was developed by the Insurance Sector Education and Training Authority (INSETA) after wide consultation with professional bodies such as the Insurance Institute of South Africa (IISA) and the Financial Planning Institute (FPI).

Entry Requirements

NQF Level 4 qualification (National Senior Certificate or equivalent), OR
3 years of work experience in the Insurance industry

Learning Outcomes

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

Basics of insurance principles and products
Professional behaviour and financial literacy
Claims handling procedures and protocols
Claims verification and validity assessment
Risk improvement identification and recommendations
Regulatory compliance and ethical practices

Compulsory Modules

Module 1: Basics of Insurance

• Basics of insurance

Module 2: Professional Behaviour and Financial Literacy

• Professional behaviour and financial literacy

Module 3: Claims Handling Procedures

• Claims handling procedures
• Comment on risk improvements where applicable

Module 4: Claims Handling Processes

• Receive a basic claim in order to assess the loss or damage and verify the validity of the contract
• Assess the claim to determine validity
• Recommend to settle, conditionally settle, or reject the claim

Specialisation Options (Choose One)

Module 5: Long-Term Insurance

• Receipt of notifications and verification processes regarding long-term insurance
• Assessment process regarding long-term insurance
• Decisions for payments to relevant stakeholders regarding long-term insurance

Module 6: Short-Term Insurance

• Verification processes regarding short-term insurance
• Participation in the assessment process regarding short-term insurance
• Making recommendations regarding short-term insurance

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 claims
• 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

SAQA ID 99668

Career Opportunities

Insurance Claims Administrator
Insurance Claims Assessor
Long-term Insurance Claims Handler
Short-term Insurance Claims Handler
Statutory Claims Assessor
Health Care Claims Administrator
Claims Verification Officer
Claims Processing Specialist

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