Claims Assessor

Vitality; Sandton; Híbrido; ZAR 480.000 - 580.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Bonus Schemes

Retirement support

Health & wellbeing

Financial protection

Descripción de la vacante

Vitality is seeking a Claims Specialist - Life in a hybrid role based in Sandton, SA. You will assess Life Cover, Terminal Illness and tiered Critical Illness claims, interpret complex medical evidence and make fair, well-reasoned decisions.

The role involves collaboration with underwriters, reinsurers and broader stakeholders to maintain high standards. You will review records, guide junior colleagues, and contribute to training and knowledge sharing across the team.

Formación

• Assess Life Cover, Terminal Illness and tiered Critical Illness claims with fair, well-reasoned decisions.
• Review medical records and supporting evidence to determine claim validity.
• Identify fraud, non-disclosure and pre-existing conditions during claims assessment.

Responsabilidades

• Assess Life Cover, Terminal Illness and tiered Critical Illness claims with fair, accurate decisions in line with UK practices.
• Review medical records and supporting documentation to determine claim validity.
• Provide technical mentoring and coaching to junior colleagues and deliver case study sessions.

Conocimientos

Extensive Claims Assessment

Expertise Strong Medical Evidence

Analysis Proven TechnicalCommunication

Descripción del empleo

About The Role

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

These are just some of the many perks that we offer! To view the extensive range of benefits we offer, please visit our careers page. Fantastic Benefits. Exciting rewards. Great career opportunities!

If you are successfulin 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.

About Us

Vitality South Africa plays a key role in the development and delivery of the shared‑value insurance model within the Discovery Group. The team leads key strategic initiatives in the South African market, strengthens alignment across the organisation, and ensures the successful implementation of Vitality’s health and wellness programmes. In addition, the team provides specialised expertise, cutting edge technology, behavioural science and health and wellness, drawing on both global innovation and local market insight.Roles within Vitality South Africa are dynamic and fast‑paced. As such, we are seeking individuals who are adaptable, solutions‑oriented, and capable of delivering high‑quality, sustainable value in a complex and evolving environment.

Employment Equity:

The Company’s approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.