Senior Claims Agent

Pineapple Tech PTY LTD is a dynamic and innovative short-term insurance company that leverages technology to provide exceptional insurance solutions to our customers. We believe in making insurance simple, transparent, and accessible to all. As we continue to grow, we are currently seeking a professional and experienced Senior Claims Agent to join our dynamic and growing organisation.

Position Overview

The Senior Claims Agent role is responsible for managing the full lifecycle of motor insurance claims from registration through to resolution. This includes deep validations, fraud risk flagging, SLA and pending ownership, and adherence to compliance and Treating Customers Fairly (TCF) principles. Senior Claims Agents work independently and serve as key quality drivers across the claims process. This is a high-accountability role for professionals who take ownership of their work, uphold regulatory standards, and thrive in a performance-focused environment.

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

If you are interested and meet the above requirements , please email your updated resume (cv) tohttps://my.wamly.io/invite/Pineapple/34fe1f59

The closing date for applications is Friday, 02 January 2026
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