Senior Claims Agent Job at Pineapple

Key Objectives and Responsibilities:

• General duties and responsibilities of a Senior Claims Agent at Pineapple include but not limited to :

Claim Handling and Validation

• Conduct thorough claim validations, ensuring accuracy, policy compliance, and identification of potential fraud or irregularities
• Review supporting documents, system history, and case details to determine coverage, liability, and mandate-based next steps
• Make sound recommendations on authorisation or referral within company protocols

Client Engagement and Communication

• Own the client journey from registration to finalisation, providing clear and empathetic updates throughout
• Communicate in a professional, structured manner while tailoring tone to client context
• Manage expectations effectively and respond to queries promptly across multiple communication channels

Compliance and Risk Adherence

• Operate in strict alignment with Pineapple’s SOPs, Treating Customers Fairly (TCF) principles, and regulatory requirements
• Escalate red flags, suspicious matters, or complex cases via the appropriate internal channels
• Adhere to audit requirements by ensuring proper documentation and system notes are maintained

Workflow, Systems, and Administration

• Maintain complete and accurate records on systems
• Load and manage tickets, ensuring timelines are met and SLA targets are upheld
• Reduce pending volumes proactively by identifying bottlenecks and following up on unresolved issues

Collaboration and Cross-Functional Support

• Work effectively with internal stakeholders such and drive operational flow
• Provide peer-level support to junior agents by modelling high performance and SOP-aligned conduct
• Participate in team discussions, process reviews, and knowledge-sharing initiatives

Growth and Contribution

• Engage actively in training, compliance updates, and departmental upskilling programs
• Offer suggestions for process improvement or client experience enhancement based on real-time case insights
• Demonstrate professionalism, independence, and problem-solving capability at all times

Qualifications and Skills:

• Matric
• FAIS Qualification (NQF), Class of Business, RE5 will be advantageous.
• Minimum of 3 years experience in claims, preferably within the insurance industry
• Must meet all Regulatory Fit and Proper requirements for the role
• Strong interpersonal and communication skills
• Strong administrative skills and attention to detail
• A genuine passion for customer satisfaction and a problem-solving mindset

Knowledge:

• End to end motor claims workflow
• TCF & Fais principles
• Fraud Indicators & identification
• Service provider Process
• Red Flag identification
• Customer complaint management