Life Claims Assessor

Isilumko Staffing; Johannesburg; On-site; ZAR 200,000 - 300,000; Full time

Job summary

A prominent staffing agency in Johannesburg is seeking a claims assessor to ensure claims are evaluated accurately and communicated effectively while meeting business rules. The ideal candidate will have 3–5 years of experience in Life Claims Assessment and relevant qualifications in health-related fields. The role requires strong communication skills and a commitment to quality assurance, providing a dynamic environment for growth and efficiency.

Qualifications

• 3–5 years in Life Claims Assessment (Death, Disability, Severe Illness).
• 2–3 years in Underwriting.
• Knowledge of medical terminology preferred.

Responsibilities

• Assess an average of 7 benefits per day.
• Independently assess claims within authority limits.
• Present complex claims to internal committees for verification.

Skills

Claims assessment accuracy

Formal communication

Quality Assurance

Education

Diploma/bachelor’s in health-related field

Risk management knowledge

Job description

Overview

Primary Purpose of the Role: To ensure claims are assessed accurately and communicated effectively, in line with business rules and service level agreements.

Responsibilities

• Assess an average of 7 benefits per day.
• Communicate formally and professionally.
• Independently assess claims within authority limits.
• Maintain service level discipline.
• Achieve Quality Assurance score above 85%.
• Present complex claims to internal committees for verification.

Requirements

Work Experience:

• 3–5 years in Life Claims Assessment (Death, Disability, Severe Illness).
• 2–3 years in Underwriting.

Education:

• Required: Matric + Diploma/bachelor’s in health-related field (Nursing, OT, Physio) or equivalent experience.
• Preferred: Risk management and medical terminology knowledge.