Optimising claims processing for employee benefits

A smooth claims process helps employees get the benefits they’re entitled to — and keeps frustration at bay. But delays, documentation issues, and lack of communication are still common. This guide outlines how to streamline each stage of the process and manage disputes more effectively.

The claims timeline challenge

Average processing time in SA: 18 working days (FAIS Ombud, 2023).

Detailed Claims Workflow

• Submission

  • Via insurer portal or email
  • Required documents checklist

• Adviser Review

  • Verification process
  • Common rejection reasons

• Payout

  • EFT within 3 days of approval
  • Dispute resolution process

Toolkit

• Claims status tracker template
• Sample escalation email

Next steps

• Use the Contact me button to book a consultation with me to help you further.
• Access further resources on the Adviser portal here.