Senior Claims Assessor

Vitality; Sandton; Hybrid; ZAR 700,000 - 1,000,000; Full time

Benefits offered by this job

Bonus schemes

Retirement match up to 5%

Health & wellbeing – Discovery Medical

Life assurance and income protection

Disability insurance

Job summary

Vitality is seeking a Senior Claims Assessor to evaluate Income Protection claims, considering medical, financial and contractual factors to reach well‑evidenced decisions. The role focuses on high‑quality claims experience and will involve identifying potential fraud while engaging with stakeholders.

It also supports knowledge sharing and improvements to products and systems. The role requires depth of medical understanding and strong communication to explain decisions clearly, plus

Qualifications

• 3-5 years’ experience within a life insurance claims environment.
• Intermediate knowledge of the Life Insurance industry and claims management principles.
• Knowledge of medical conditions and diagnoses with application to claims assessment.
• Strong written and verbal communication skills.
• Proven ability to make sound decisions with minimal supervision.
• Experience collaborating with internal and external stakeholders to progress cases.

Responsibilities

• Assess Income Protection claims through detailed medical and financial assessment, aligning with industry best practice and service levels.
• Review evidence, policy terms and circumstances to determine contractual validity of claims.
• Identify potential fraud, misrepresentation and pre-existing conditions in complex cases.
• Collaborate with stakeholders to gather information and reach evidence-based decisions.
• Manage complaint resolution professionally and communicate decisions clearly.
• Apply medical knowledge to support accurate claims assessment.
• Share technical knowledge to strengthen team capability and consistency.
• Coach administrators to develop team capabilities.
• Contribute insights to product development and system enhancements.

Skills

Strong Income Protection Claims Assess

Proven Medical Claims Knowledge

Sound Complex Claims Judgement

Education

Certificate of Proficiency in life insurance

Medical degree or diploma

Tools

Microsoft Office (Outlook, Excel, Word)

Job description

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:

• Strong Income Protection Claims Assessment
• Proven Medical Claims Knowledge
• Sound Complex Claims Judgement

What this role is all about

We’re looking for a Senior Claims Assessor to assess Income Protection claims, taking ownership of medical, financial and contractual considerations to reach fair and well‑evidenced decisions. The role plays an important part in delivering a high-quality claims experience, using sound judgement to identify potential fraud, misrepresentation and pre‑existing conditions while working closely with internal and external stakeholders. Alongside managing claims, the role will contribute specialist knowledge across the team, support colleague development and provide input into improvements to products and systems.

What you'll be doing

• Assess Income Protection claims through detailed medical and financial assessment, ensuring decisions align with UK industry best practice and required service levels
• Determine the contractual validity of claims by reviewing the available evidence, policy terms and relevant circumstances
• Identify and investigate potential fraud, misrepresentation and pre‑existing conditions, applying sound judgement to complex or sensitive cases
• Work closely with internal and external stakeholders to gather relevant information and reach clear, evidence‑based claim decisions
• Manage complaint resolution effectively, handling challenging situations professionally and communicating decisions clearly
• Apply strong medical knowledge when reviewing conditions and diagnoses to support accurate and appropriate claims assessment
• Share technical and medical knowledge across the team to strengthen claims capability and support consistent decision‑making
• Coach and support administrators, providing guidance and sharing expertise to develop capability within the wider team
• Contribute specialist claims insight to product development and system enhancements, helping improve processes and the overall claims service

What do you need to thrive?

• 3-5 years’ experience within a life insurance claims environment, with strong practical claims assessment experience
• Intermediate knowledge of the Life Insurance industry and the principles underpinning effective claims management
• Intermediate to advanced understanding of medical conditions and diagnoses, with the ability to apply this knowledge during claims assessment
• Strong written and verbal communication skills, with the confidence to present information and explain decisions clearly
• Proven ability to make sound decisions, take initiative and manage work effectively with minimal supervision
• Strong collaboration skills, with experience working across internal and external stakeholders to progress cases and reach decisions
• Ability to manage conflict, complaints and challenging situations professionally and effectively
• Strong customer focus with the ability to deliver results while maintaining appropriate service standards
• Competent Microsoft Office skills, including Outlook, Excel and Word
• Experience within the UK Life Claims environment, a Certificate of Proficiency in life insurance, or a medical degree or diploma would be advantageous

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 the 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.