Technical Claims Assessor

nedbank; Durban; On-site; ZAR 250,000 - 450,000; Full time

Job summary

A leading financial services company in South Africa is looking for a Technical Claims Assessor to manage long-term insurance claims. The successful candidate will be responsible for ensuring accurate assessments and prompt payment of claims while building effective relationships with clients and stakeholders. This role requires a strong background in insurance, medical underwriting, and exceptional communication skills.

Qualifications

• 3-6 years as a Technical Claims Assessor.
• 2-3 years in Long Term Insurance.
• Medical underwriting experience required.

Responsibilities

• Assess and process long-term insurance claims accurately.
• Develop relationships with stakeholders for claims management.
• Adhere to service level agreements and legal requirements.

Skills

Communication Skills

Decision Making

Customer Orientation

Planning and Organizing

Education

Matric / Grade 12 / National Senior Certificate

Professional Qualifications/Honour’s Degree

Tools

Relevant software and systems knowledge

Job description

• 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.

Job 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/Honour’s 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
• Customer Orientation
• Monitoring Information
• Decision Making
• Initiating Action
• Work Standards
• Planning and Organizing
• Communication

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Nedbank Ltd Reg No 1951/000009/06.
Authorised financial services and registered credit provider (NCRCP16).

For assistance please contact the Nedbank Recruiting Team at [phone]