Claims Assessor

Primary Purpose of the Role:

To ensure claims are assessed accurately and communicated effectively, in line with business rules and service level agreements.

Key Responsibilities:

• Assess an average of 7 benefits per day.
• Communicate formally and professionally.
• Independently assess claims within authority limits.
• Maintain service level discipline.
• Achieve Quality Assurance score above 85%.
• Present complex claims to internal committees for verification.

Requirements:

Work Experience:

• 3–5 years in Life Claims Assessment (Death, Disability, Severe Illness).
• 2–3 years in Underwriting.

Education:

• Required: Matric + Diploma/bachelor’s in health-related field (Nursing, OT, Physio) or equivalent experience.
• Preferred: Risk management and medical terminology knowledge.