Claims Assessor (Disability)

Fedgroup; Gauteng; On-site; ZAR 300,000 - 450,000; Full time

Job summary

A leading company in the insurance sector is seeking a detail-oriented Disability Claims Assessor to lead the management of long-term insurance claims, focusing on disability and critical illness. The ideal candidate will possess relevant medical qualifications and a proven track record in Group Risk claims, with strong communication and organizational skills. This pivotal role requires someone passionate about vocational rehabilitation and committed to delivering high-quality service.

Qualifications

• Minimum of 2 years' experience in assessing Group Risk claims, particularly disability claims.
• Solid understanding of Long-Term Insurance and Group Risk products.
• Experience with Vocational Rehabilitation programs is advantageous.

Responsibilities

• Accurately assess and manage long-term insurance claims.
• Prepare for and participate in Claims Management Committee meetings.
• Communicate assessment decisions clearly through documentation.

Skills

Interpersonal skills

Communication skills

Attention to detail

Problem-solving

Time management

Education

Relevant Medical Qualification (Occupational Therapy, Physiotherapy, Nursing)

Job description

We're looking for a detail-oriented and analytical Disability Claims Assessor to take the lead in assessing and managing long-term insurance claims, including disability and critical illness.

If you've got solid experience in Group Risk claims and a genuine interest in vocational rehabilitation, this could be the right opportunity for you.You'll work closely with various stakeholders to ensure claims are handled fairly, efficiently, and with care.

What to Expect :

Accurately assess, investigate, and manage long-term insurance claims, including disability and critical illness claimsPrepare draft minutes for the Claims Management Committee (CMC), outlining assessment findings and reasoningAssist in organizing and preparing for weekly CMC meetings as requiredLiaise with brokers, employers, and members to gather necessary information and provide updatesActively present claims and participate in CMC meetingsFollow up on action items from CMC meetings, liaising with reinsurers and other stakeholders as necessary to implement decisions and manage claimsCoordinate with appropriately qualified independent service providers for external examinations and appointmentsDraft clear and concise letters communicating assessment decisionsEnsure a strong understanding of the claims processing and payment proceduresLead and contribute to key projects within the claims team, including vocational rehabilitation and early intervention initiativesRespond to stakeholder queries efficiently and professionally within established turnaround timesProvide support to service providers, offering clarification and assistance as neededMaintain timely, accurate, and complete data entries on all systemsAdhere to established procedures and workflows, ensuring compliance with turnaround timesDeliver high-quality service to both internal and external stakeholders, safeguarding their interestsEnsure that claim assessments align with the company's values and standards of decision-makingFoster a collaborative and supportive team environment

What You'll Bring : Qualifications and Experience

Relevant Medical Qualification (e.g., Occupational Therapy, Physiotherapy, Nursing, etc.

Minimum of 2 years' experience in assessing Group Risk claims, with a strong background in disability claims.

Exposure to lump sum claims such as Life, Capital Disability, and Critical Illness is an advantage

Excellent interpersonal and communication skills, both verbal and writtenStrong understanding of Long-Term Insurance and Group Risk productsFamiliarity with Vocational Rehabilitation and the implementation of related programsPassion for improving processes, particularly those related to Vocational RehabilitationAbility to work independently and as part of a collaborative teamStrong time-management skills with the ability to meet deadlines and adhere to strict turnaround timesAbility to thrive under pressure, maintaining both speed and accuracyMeticulous attention to detail and effective data management skillsStrong problem-solving abilities with a pragmatic approachHighly self-motivated, proactive, and focusedCommitment to maintaining client confidentialityStrong ethical standards and integrity in all actionsWillingness to challenge the status quo and strive for excellenceAbility to drive results and deliver on commitmentsOrganized and detail-oriented with a passion for continuous learning and collaboration