Technical Claims Assessor

Nedbank Private Wealth; Durban; On-site; ZAR 300,000 - 500,000; Full time

Job summary

A leading financial services provider in Durban seeks a Technical Claims Assessor to manage long-term insurance claims. You will assess, investigate, and ensure fair payment of claims while building effective relationships with clients and stakeholders. The ideal candidate should have at least 3 years of experience as a Technical Claims Assessor, medical underwriting experience, and relevant qualifications. This is a full-time role with emphasis on customer service and teamwork.

Qualifications

• Must have a minimum of 3 years as a Technical Claims Assessor.
• At least 2 years experience in Long Term Insurance.
• Non-negotiable medical underwriting experience.

Responsibilities

• Assess and process long-term insurance claims accurately.
• Develop relationships with internal and external stakeholders.
• Drive effective teamwork and communication during claims processing.

Skills

Customer Orientation

Collaborating

Decision Making

Medical Knowledge

General Communication Skills

Education

Matric / Grade 12 / National Senior Certificate

Professional Qualifications / Honours Degree

Tools

Insurance Software

Data Analysis Tools

Job description

Overview

• Job Requisition: 140914
• TA Specialist: Refilwe Falatsi
• Closing Date: 5 August 2025
• Location: Durban
• Cluster: Personal and Private Banking Nedbank Insurance Operations - Long Term Insurance Claims
• Please Note: Preference will be given to applicants from Underrepresented Groups

Job Purpose

To accurately assess investigate and process long-term insurance claims including death disability and critical illness claims and ensure prompt and fair payment of benefits in accordance with the policy terms and conditions.

Responsibilities

Stakeholder Engagement

• Develop effective relationships with stakeholders (internal - client solutions team / client experience and external clients hospitals doctors labs and reassurers).
• Drive and support effective teamwork within the department.
• Effective client communication throughout the claims journey.
• Ensure information is provided correctly to stakeholders by maintaining and sharing knowledge.

Process Management

• Meet client needs by ensuring claims are processed according to service level agreement and insurance policy terms and conditions

Professional Development

• Engage in appropriate training interventions to promote own professional development.
• Adhere to organizational best practice and legislative requirements.
• Keep abreast of legislation and other medical industry changes that impact on the role by reading the relevant newsletters websites and attending sessions.
• Improve personal capability and stay abreast of developments in the field of expertise by identifying training courses and career progression for self through input and feedback from managers.
• Ensure personal growth and enable effectiveness in performance of roles and responsibilities by ensuring all learning activities are completed experience practiced and certifications obtained and / or maintained within specified time frames.

People Specification

Essential Qualifications - NQF Level

• Matric / Grade 12 / National Senior Certificate
• Professional Qualifications / Honours Degree

Preferred Qualification

Physiotherapy / Occupational Therapy / Nursing / Junior Doctor / Medical related degree

Preferred Certifications

Beneficial: Higher Certificate in Long Term Insurance

Minimum Experience Level

• 3 - 6 years as a Technical Claims Assessor
• 2 - 3 years Long Term Insurance
• Must have medical underwriting experience. (non-negotiable)

Technical / Professional Knowledge

• Administrative procedures and systems
• Insurance Policy Technical Knowledge
• Business principles
• Governance Risk and Controls
• Relevant regulatory knowledge
• Relevant software and systems knowledge
• Business writing skills
• Medical and Financial Knowledge
• General Communication Skills

Behavioural Competencies

• Customer Orientation
• Collaborating
• Monitoring Information
• Decision Making
• Initiating Action
• Work Standards
• Planning and Organizing
• Communication

Please contact the Nedbank Recruiting Team at

Key Skills

Intelligence, Information Technology Sales, Accounts, Auto Parts, Data Analysis

Employment Type : Full Time

Experience : years

Vacancy : 1