SUMMARY:
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POSITION INFO:
Position: Claims Assessor – Individual Life Benefits
Location: Sandton
Industry: Long-Term Insurance | Banking Client
Are you a detail-oriented professional with a passion for precision, service excellence, and impactful decision-making? Our client, a leading name in the banking and insurance space, is looking for a Claims Assessor to join their high-performing team. If you thrive in a fast-paced environment and have a knack for interpreting complex medical and legal information, this is your moment to shine.
What You’ll Be Doing:
Assess productivity targets — average of 7 benefits per day per individual
Deliver exceptional service through formal, standards-driven communication
Independently assess claims within authority limits to ensure accuracy and minimize error rates
Uphold service level agreements to maintain operational excellence
Achieve Quality Assurance scores above 85% for claims decisions and communication
Present complex claims (disputes, declines, voids) to cross-functional committees including medical, legal, underwriting, actuarial, and compliance
What You Bring:
Experience:
• 3–5 years in Claims Assessment (Death, Disability, Severe Illness) — Essential
• 2–3 years in Underwriting — Advantageous
Understanding medical codes
Education & Registration:
• Matric — Essential
• Diploma/Bachelor’s in Nursing, Occupational Therapy, or Physiotherapy — Essential
• 3–5 years of relevant claims experience, long term insurance
Skills:
• Analytical thinking
• Communication
• Decision-making
• Attention to detail
