Claims Assessor

Vitality; Johannesburg; Hybrid; ZAR 350,000 - 550,000; Full time

Benefits offered by this job

Bonus Schemes

Retirement support

Health & wellbeing

Job summary

Vitality in Johannesburg is seeking a Life Claims Case Specialist to assess Life Cover, Terminal Illness and tiered Critical Illness claims, providing expert analysis and fair decisions. The role involves technical medical evaluation, collaboration with underwriters and reinsurers, and mentoring junior staff.

The position emphasizes strong written and verbal communication, with hybrid work in Sandton and a 37.5-hour week. Experience in medical evidence interpretation is essential.

Qualifications

• Extensive experience assessing and managing Life Cover and tiered Critical Illness claims.
• Strong knowledge of the UK insurance market and regulatory environment.
• Proven experience working with reinsurers.
• Excellent written and verbal communication skills.
• Intermediate Microsoft Word, Excel and PowerPoint skills.

Responsibilities

• Assess Life Cover, Terminal Illness and tiered Critical Illness claims, making fair, accurate and well-reasoned decisions in line with UK claims practices.
• Review medical records, supporting documentation and other available evidence to determine claim validity and identify where further information is required.
• Identify and investigate potential fraud, non-disclosure, misrepresentation and pre-existing conditions, ensuring concerns are appropriately considered within the claims assessment.
• Prepare clear, accurate and professionally written claim decisions, correspondence and supporting rationale.
• Work closely with strategic underwriters, management, reinsurers and other key stakeholders to support accurate and timely claim outcomes.
• Apply strong technical judgement to complex or sensitive cases, balancing available medical evidence, policy information and relevant claims considerations.
• Support the resolution of complaints through thorough investigation, clear decision-making and professional written and verbal communication.
• Provide technical mentoring and coaching to junior colleagues, supporting the development of their claims knowledge and assessment capability.
• Develop and deliver case study sessions and training on specialist claims topics, sharing knowledge and best practice across the team.

Skills

Extensive Claims Assessment

Expertise Strong Medical Evidence

Analysis Proven TechnicalCommuni c at

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Job description

Team - Case Specialist - Life

Team - Case Specialist - Life

Working Pattern - Hybrid - 2 days per week in the Vitality Sandton Office. Full time, 37.5 hours per week.
We are happy to discuss flexible working!

Top 3 Skills Needed For This Role

• Extensive Claims Assessment
• Expertise Strong Medical Evidence
• Analysis Proven Technical Communication

What This Role Is All About

We’re looking for a Claims Assessor to join our Claims team, taking responsibility for the assessment and management of Life Cover, Terminal Illness and Critical Illness claims. This is a specialist role requiring strong technical claims expertise, sound judgement and the ability to interpret complex medical and supporting evidence to reach fair and accurate decisions. The role will also provide technical support and development to colleagues, working closely with underwriters, reinsurers and wider stakeholders to maintain high standards of claims assessment.

Key Actions

• Assess Life Cover, Terminal Illness and tiered Critical Illness claims, making fair, accurate and well-reasoned decisions in line with UK claims practices
• Review medical records, supporting documentation and other available evidence to determine claim validity and identify where further information is required
• Identify and investigate potential fraud, non-disclosure, misrepresentation and pre-existing conditions, ensuring concerns are appropriately considered within the claims assessment
• Prepare clear, accurate and professionally written claim decisions, correspondence and supporting rationale
• Work closely with strategic underwriters, management, reinsurers and other key stakeholders to support accurate and timely claim outcomes
• Apply strong technical judgement to complex or sensitive cases, balancing available medical evidence, policy information and relevant claims considerations
• Support the resolution of complaints through thorough investigation, clear decision-making and professional written and verbal communication
• Provide technical mentoring and coaching to junior colleagues, supporting the development of their claims knowledge and assessment capability
• Develop and deliver case study sessions and training on specialist claims topics, sharing knowledge and best practice across the team

What do you need to thrive?

• Extensive experience assessing and managing Life Cover and tiered Critical Illness claims
• Strong knowledge of the UK insurance market and regulatory environment
• Proven experience working with reinsurers
• Strong medical and claims assessment capability, including interpreting complex supporting evidence
• Excellent written and verbal communication skills with the ability to clearly explain and document technical decisions
• Confidence presenting technical information and delivering training to colleagues
• Intermediate Microsoft Word, Excel and PowerPoint skills

So, what’s in it for you?

• Bonus Schemes - A bonus that regularly rewards you for your performance
• Retirement support - We will match your contributions up to 5% of your salary
• Health & wellbeing - Discovery Medical Health Scheme
• Financial protection - Life assurance, income protection and short and long-term disability insurance

If you are successful in your application and join us at Vitality, this is our promise to you, we will:

• Help you to be the healthiest you’ve ever been.
• Create an environment that embraces you as you are and enables you to be your best self.
• Give you flexibility on how, where and when you work.
• Help you advance your career by playing you to your strengths.
• Give you a voice to help our business grow and make Vitality a great place to be.
• Give you the space to try, fail and learn.
• Provide a healthy balance of challenge and support.
• Recognise and reward you with a competitive salary and amazing benefits.
• Be there for you when you need us.
• Provide opportunities for you to be a force for good in society.

We commit to all these things because we want you to feel that you belong, and are supported to be happy and healthy.