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Claims Assessor

Claims Assessor

Discovery LimitedZA
17 days ago
Job description

Job title : Claims Assessor

Job Location : Gauteng,

Deadline : October 11, 2025

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Key Purpose

  • The role contributes to the organisational goals by assessing, validating and finalising of all Life Cover, Serious Illness Cover, Income Protection Cover, Disability Cover claims according to the policy terms and condition whilst still adhering to service level agreements and maintaining high service standards.

    • Areas of responsibility may include but not limited to :

    The successful applicant will be responsible for but not limited to the following job functions :

  • The role of a Specialist Claims Assessor is to assess all claims. This will predominately include the highest value claims coming in, complex claims and escalations.
  • They will be required to manage a larger and more intricate portfolio to ensure that necessary turnaround times are met.
  • Skilled liaison between the advisers, customers, and internal and external stakeholders
  • Assistance with complaint resolution, including escalated complaint calls and FOS cases.
  • Facilitating and chairing the bi weekly complex claims meetings within the team
  • Coaching and upskilling junior members of the team.
  • Review and approval of claim decisions that fall outside of other assessor’s financial authority limits when necessary. This includes the review of any written communication relating to the claim decision.
  • Provide input into product development and system enhancements.
  • Providing managerial support in managers absence

    • Personal Attributes and Skills

  • Deciding and initiating action
  • Working with People
  • Able to work unsupervised and to take initiative
  • Adhering to Principles and Values
  • Presenting and Communicating Information
  • Conflict handling and resolution
  • Collaboration and team work
  • Learning and Researching
  • Delivering Results and Meeting Customer Expectations
  • Following Instructions and Procedures
  • Adapting and Responding to Change
  • Coping with pressure and setbacks
  • Achieving Personal Work Goals

    • Technical Skills

  • Effective Communication Skills (verbal & written)
  • Analytical
  • Conflict handling
  • Soft skills

    • Education and Experience :

    Education

  • Matric / Grade 12 is essential
  • Biology
  • A minimum of 5 years prior experience within a claims environment in the life insurance industry is essential.
  • COP (Certificate of Proficiency) in life insurance would be advantageous.
  • Medical degree or diploma would be advantageous.

    • Knowledge :

  • Microsoft Office skills, i.e. Outlook, Excel and Word are mandatory.
  • Extensive knowledge of our product in the Life Insurance Industry.
  • Experience within the UK Life Insurance Industry would be advantageous.
  • An advanced level of understanding of medical conditions and diagnoses
  • Basic Financial / Accounting knowledge would be advantageous.
  • Experience in Vitality Life Claims system would be advantageous.
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    Assessor • ZA