Group Claims Assessor

SUMMARY:
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POSITION INFO:

Purpose of the Role:

This role exists because claims are the heart of our business, it's the moment when our promise becomes real. At Dis-Chem Life, paying a valid claim is not just a transaction, it is the fulfilment of trust and commitment to our policyholders and their families.

The Group Claims Assessor ensures that every claim is treated with urgency, fairness, and compassion, actively looking for opportunities to honour and pay valid claims. At the same time, the role protects the business and our customers by ensuring that every claim is legitimate, compliant, and above board.

By striking the right balance between compassion and compliance, this role upholds Dis-Chem Life’s reputation, strengthens customer trust, and safeguards the sustainability of our business. 

Role Summary:

As our Group Claims Assessor, you will be responsible for the end-to-end assessment of group claims, ensuring they are processed within strict turnaround times and to the highest standard of accuracy.

You will balance two priorities:

• Efficiency and Compliance: Ensuring claims are validated against policy terms, exclusions, and regulatory frameworks, with a keen eye for fraud detection.
• Compassionate Service: Providing clear, empathetic communication and guidance to claimants and beneficiaries during a sensitive and emotional time.

Success in this role means claims are processed quickly, fairly, and transparently, reinforcing trust in Dis-Chem Life’s commitment to doing what’s right.

Benefits:

• Competitive Salary
• Opportunity to be part of a forward-thinking team and to grow within a fast-scaling business.
• Access to ongoing training and development programs to build claims expertise.
• Exposure to modern claims management systems and tools to support efficient and accurate assessments.
• Be part of a company committed to nurturing talent and offering career advancement opportunities.
• The chance to influence the future of life insurance in South Africa and contribute to high-impact projects.

Key Responsibilities:

• Review and validate all submitted group claims and documentation against policy terms, exclusions, and conditions.
• Accurately calculate claim payouts and make approval/rejection recommendations in line with authority levels.
• Ensure claims are assessed and processed within agreed SLAs and with near-zero error rates.
• Provide empathetic, clear, and timely updates to claimants, ensuring sensitivity in all interactions.
• Clearly explain required documentation, claims procedures, and outcomes to beneficiaries and group Human Resources teams
• Identify, flag, and escalate suspicious or fraudulent claims with full supporting evidence.
• Ensure strict adherence to FSCA, TCF, POPIA, Guardrisk, Gen Re, and internal claims policies.
• Maintain complete, auditable records of all claims assessments, decisions, and communications.
• Liaise with Finance, Underwriting, Compliance, and external stakeholders (e.g., reinsurers) to ensure seamless claims resolution.

Soft Skills:

• Demonstrates high empathy and emotional intelligence, providing compassionate support to grieving clients while maintaining professional composure.
• Maintains strong attention to detail, ensuring accuracy in claims assessment and documentation.
• Communicates clearly and sensitively, both verbally and in writing, explaining processes and outcomes to clients.
• Remains resilient under pressure, managing high volumes of claims without compromising quality.
• Exhibits integrity and ethical decision-making in all claims-related activities.
• Collaborates effectively with colleagues and external stakeholders to ensure smooth and timely claims resolution.

Technical Skills:

• Solid knowledge of insurance principles claims processes, and policy wordings.
• Proficiency in claims management systems and Microsoft Office Suite.
• Ability to accurately calculate claim benefits and apply policy conditions.
• Working knowledge of regulatory frameworks (FSCA, TCF, POPIA).
• Strong fraud awareness and escalation judgment.

Experience:

• Minimum: 2–3 years’ experience in group risk benefits claims or group claims 
• Strong track record of working in a high-volume claims environment.
• Hands-on experience with policy interpretation, exclusions, and regulatory compliance.
• Exposure to fraud investigation or fraud detection in insurance (advantageous).

Qualifications and Requirements:

• Matric (Grade 12) required.
• Diploma or degree in Insurance, Finance, or related field advantageous.
• Relevant insurance/claims certifications or FAIS compliance (advantageous).
• Clear credit and criminal record.