Position Overview
As a Claims Assessor, you will be reporting to the Team Leader : Claims Assessor. You will be responsible for adjudicating and processing claims in an effective and efficient manner within the prescribed guidelines set out by Rand Mutual Assurance.
What Will You Do?
Claims Adjudication
- Verify claims captured for correctness and compliance
- Capture / accept additional information on claims i.e. medical reports
- Ensure all documents required to process a claim are indexed and filed into the system
- Add meaningful and accurate notes to ensure complete synopsis of claim on the system
- Update requirements on claims and ensure they are always accurate and up to date
Claims Management
Manage claims in line with individual targetsReview of claims in line with process, authority limits and within agreed timelinesEscalate where required within authority limitsManagement of medical reports for claims with Permanent DisabilityCommunicate claims process to both the employer and employee as set out in the claim’s management processesTimeous management of workflows and notificationsAdjudicate and Process Payments for Claims
Adjudication and processing of TTD benefits including approval within authority limitsAdjudicating and processing payment of sundry invoices within authority limitsProcess Permanent Disability claimsCustomer Service
Regularly communicate and liaise verbally and in writing with customers / suppliers / visitors / enquirers and relevant staffInterpret and respond clearly and effectively to spoken requests over the phone or in person, and to verbal or written instructionsManage walk-in queries as and when required in line with the RMA Service CatalogueHandle customer inquiries both telephonically and by emailResearch required information using available resourcesProvide customers with accurate product and service information in an efficient mannerUpdate existing customer personal information on the systemDeal with all customers in a professional and empathetic mannerWhat Will You Get In Return?
We offer great opportunities for personal and professional development in a stable company that is 130 years strong. The role comes with a competitive salary package and various benefits. Furthermore, you will be part of a dedicated group of colleagues who value teamwork and collaboration.
Turnaround Time
The shortlisting process will only start once the advert due date has been reached. The time taken to complete this process will depend on how far you progress within the recruitment process and the availability of our managers. Kindly note that if you do not receive a response within 21 days, please consider your application unsuccessful.
Closing Date
16th November 2025
Our Commitment to Transformation
In accordance with the employment equity plan of Rand Mutual Assurance and its employment equity goals and targets, preference may be given, but is not limited, to candidates from under-represented designated groups.
Job Requirements
FAIS Regulatory Examination (RE5) (Essential)NQF Level 5 Higher Certificate in a FAIS Recognised Qualification (Essential)A medical qualification (Advantageous)3 to 5 years claims related experience (Essential)Intimate knowledge of the COID ActGood Administrative skillsAdvanced Excel SkillsKnowledge of Claims processing, approvalInsurance and / or Medical Aid experienceDeadline drivenSeniority Level
Mid‑Senior levelEmployment Type
Full‑timeJob Function
Finance and SalesIndustries
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