Claims Assessor Specialist

FNB South Africa; Johannesburg; On-site; ZAR 350,000 - 550,000; Full time

Job summary

FNB South Africa is seeking a proactive Risk Claims Assessor to apply loss control processes and monitor recovery within FR Life Assurance. The role focuses on assessing long-term insurance claims, including impairment, disability, income replacement, death and critical illness, ensuring decisions reflect company values.

The ideal candidate will have a medical qualification (OT/Physio/Biokineticist), 3+ years in medical claims assessment, and exposure to long-term insurance environments, with

Qualifications

• At least 3 years of medical claims assessment experience.
• Experience in long-term insurance environments.
• Experience dealing with Ombudsman/ escalated queries.

Responsibilities

• Accurately assess, investigate and manage long-term insurance claims including impairment, disability, income replacement, death and critical illness claims.
• Ensure claims assessment aligns with company values and policy.
• Identify fraudulent activity, policy abuse and pre-existing conditions; escalate when needed.
• Provide professional service to customers, advisors and branches via phone and written correspondence.
• Take ownership of queries and resolve them timeously.

Skills

Medical claims assessment experience

Ombudsman handling

Insurance claims investigation

Education

Occupational Therapy / Physiotherapy / Biokineticist qualification

Tools

ASISA life insurance claims assessor course

Job description

Job Description

To apply loss control processes within the organisation, including the follow up of special investigations and monitoring recovery

Hello Future Risk Claims Assessor,

Welcome to FNB, the home of the #changeables. We design for the shapeshifters and deliver products and services that make us incredibly proud of people that make it happen.

As part of our talented team in FR Life Assurance, you will be surrounded by unique talents, diverse minds, and an adaptable environment that lives up to the promise of staying curious. Now’s the time to imagine your potential in a team where experts come together and ignite effective change

Are You Someone Who Can

• Accurately assess, investigate and manage long-term insurance claims including Impairment, Disability, income replacement, death and critical illness claims.
• Ensure that the claims assessment and that the standard of decision is consistent with the company values and philosophy.
• Ensure all risks are mitigated and escalated; this includes the identification of fraudulent activity, policy abuse and pre-existing conditions.
• Provide effective, efficient and professional service to all our customers, advisors and branches, both telephonically and through written correspondence.
• Take ownership of queries and ensuring they are resolved timeously and effectively.
• Ensure adherence to organizational best practice and legislative requirements.
• Teamwork to meet service and quality standards.
• Deliver exceptional service that exceeds customers’ expectations through proactive, innovative and appropriate solutions.

You Will Be An Ideal Candidate If You

• Have a suitable medical qualification (Occupational Therapy, Physiotherapy and or biokineticist)
• At least 3 years’ medical claims assessment experience
• Worked in a Long-term insurance environment.
• Experience in dealing with Ombudsman / escalated queries.
• Nursing background will be advantageous.
• ASISA Life insurance claims assessor course as a requirement- would be advantagous

You Will Have Access To

• Opportunities to network and collaborate.
• A challenging working environment
• Opportunities to innovate.

We Can Be a Match If You Are

• Adaptable and curious
• Have a proven successful track record.
• Thrive in a collaborative environment.

Are you interested to take the step? We look forward to engaging with you.

All appointments will be made in line with FirstRand Group’s Employment Equity plan. The Bank supports the recruitment and advancement of individuals with disabilities. In order for us to fulfill this purpose, candidates can disclose their disability information on a voluntary basis. The Bank will keep this information confidential unless we are required by law to disclose this information to other parties.

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18/11/26

All appointments will be made in line with FirstRand Group’s Employment Equity plan. The Bank supports the recruitment and advancement of individuals with disabilities. In order for us to fulfill this purpose, candidates can disclose their disability information on a voluntary basis. The Bank will keep this information confidential unless we are required by law to disclose this information to other parties.