Life Claims Assessor - Expert Evaluations & Mentoring

Vitality; Johannesburg; Hybride; ZAR 350 000 - 550 000; Plein temps

Avantages offerts par ce poste

Bonus Schemes

Retirement support

Health & wellbeing

Résumé du poste

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.

Responsabilités

• 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.

Connaissances

Extensive Claims Assessment

Expertise Strong Medical Evidence

Analysis Proven TechnicalCommuni c at

Outils

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Description du poste

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.