Responsible for claims assessing and related administrative functions within the Credit Life Claims Team, covering Long-Term Insurance products.

This is a hands-on Life Insurance Claims Assessment role. The successful candidate must have experience personally assessing Life Insurance claims, interpreting policy terms and conditions, and making final claim decisions across a range of claim benefits.

Key Responsibilities

• Assess Life Insurance claims and make final claim synopsis decisions across a range of benefits, including:

  • Death

  • Funeral

  • Lump Sum Disability

  • Cancer

  • Critical Illness

  • Retrenchment

  • Medical Premium Waiver

  • Road Accident Injury

  • Temporary Disability

• Process and check individual Life Insurance claims as part of the full assessment process.

• Investigate claims and obtain all documentation required to reach an informed claim decision.

• Follow up with clients regarding outstanding claim documentation.

• Request affidavits from clients confirming unemployment status for continued retrenchment benefit payments.

• Interact with medical aids, hospitals and medical practitioners to obtain medical history and information relevant to claim assessment and decision-making.

• Interpret and apply Life Insurance policy terms and conditions when assessing claims.

• Liaise with reinsurance companies regarding claim decisions and outcomes.

• Deal directly with client queries telephonically and via email.

• Arrange and approve claim payments.

• Draft reports and compile claim timelines for Management.

• Provide input into claim-related template and process improvements.

• Compile and collate claim case data files required for Auditors.

• Perform other claims-related administrative functions as required.

Skills Required

• Thorough understanding of Life Insurance business, products and claims assessment.

• Ability to interpret and apply policy terms and conditions and administration principles.

• Excellent investigation and analytical skills.

• Strong attention to detail and high level of accuracy.

• Excellent written, reporting and verbal communication skills.

• Good negotiation and customer engagement skills.

• Intermediate MS Office skills, particularly Excel, Word and Outlook.

• Strong planning, organising and time-management skills.

• Ability to work independently and as part of a team.

• Creative thinking, learning and research ability.

• Ability to deliver results and meet customer expectations.

• Ability to cope with pressure and setbacks.

• Commitment to meeting daily targets and SLAs.

Requirements

• Matric and tertiary qualification.

• Minimum 3 years' experience in Life Insurance claims processing AND assessing various claim benefits.

• Relevant Life Insurance industry certification such as Wealth Management, RE5 or Claims Assessing would be advantageous.

CRITICAL SCREENING REQUIREMENT

This is a Claims ASSESSOR position — not a Claims Administrator/Claims Processor position.

Candidates must have hands-on experience assessing Life Insurance | Medical Aid claims and making the final claim decision/synopsis themselves.

Candidates whose experience is primarily limited to capturing claims, checking documentation, requesting outstanding information, updating systems, handling queries or preparing claims for a senior assessor to make the final decision will NOT meet the core requirement.

Application Notice

We receive a high volume of applications and carefully review each one. If you do not hear from us within 14 days, please consider your application unsuccessful. By applying, you consent to your information being processed and stored for recruitment purposes in line with POPIA.