Senior PI Claims Assessor

Overview

Responsible for the assessment and management of long-term Sickness, Permanent Incapacity, and Disability claims. The incumbent applies specialist claims expertise, deep process knowledge, and a client-centric approach to deliver high-quality service. The role involves handling complex and technical claims queries and complaints, ensuring superior service experience. Collaboration with the Research & Development team is essential to support cross-functional and broader organisational objectives.

Education

• Degree in Occupational Therapy/Physiotherapy or any relevant clinical qualification

Experience

• 5+ years’ experience in the insurance industry
• 4+ years’ experience in claims assessment including Income protection, Lump Sum Disability and dread disease
• Case Management experience (preferred)

Knowledge And Skills

• Must have excellent telephone etiquette
• Good computer knowledge - MS Outlook, Excel and Word are necessary
• Ability to work independently as well as being a good team-player with excellent interpersonal skills
• Logical and analytical
• Effective time management skills
• Deadline/target driven, with ability to work under pressure
• Logical and analytical
• Excellent report writing and presentation skills

Competencies

• Planning and organizing
• Attention to detail
• Client centricity
• Building and maintaining relationships
• Resilience
• Complex problem solving
• Adapting and responding to change
• Innovation and Forward Thinking

• Assess and manage long-term Sickness, Permanent Incapacity, and Disability claims in line with policy and procedural guidelines
• Review, analyse, and summarise medical documentation to support informed decision-making
• Evaluate technical aspects of claims, including potential non-disclosure and applicable exclusions
• Present complex claims to the Medical Officers Committee for further assessment and decision-making
• Draft comprehensive referral letters to independent specialists and detailed decision letters to members
• Manage long-term claims by coordinating rehabilitation and return-to-work programs in collaboration with appointed specialists
• Communicate claims outcomes and future claim requirements to members, ensuring clarity and transparency
• Manage Arbitration and Ombudsman cases, working closely with relevant stakeholders throughout the complaints process
• Demonstrate consistent adherence to audit requirements to support compliance and governance standards
• Serve as a Subject Matter Expert (SME) by sharing specialist knowledge and providing technical guidance to colleagues and stakeholders