Disability Claims Assessor

Job Description

• The role involves assessing and managing disability claims in line with product and contractual guidelines, ensuring holistic evaluations based on medical, occupational, and other relevant information. 
• The successful candidate will oversee a portfolio of clients, providing training, education, and insights on claims trends, while maintaining strong relationships through proactive support.
• Additionally, responsibilities include optimizing processes, collaborating with corporate teams, managing organizational risks, ensuring regulatory and operational compliance, and fostering personal capability development through continuous learning and industry engagement.

Key Result Areas: 

• Assess disability claims according to product and contractual guidelines  
• Performing an holistic assessment of disability claims, based on medical, occupational and other information received, and applying contractual terms and conditions to determine the validity of each claim.

Management of claims in payment

• Optimal and timeous management of income protection portfolio of claims in payment, which encompasses reviews, return to work planning, case management and termination of benefits.

Manage a portfolio of clients

• Manage a portfolio of clients by providing training, education, and presentations on claims trends. Deliver regular reports and insights while handling client enquiries efficiently. Build strong relationships through proactive support and effective communication.

Process optimization

• Ongoing process optimisation & improvements within the team with a focus on implementing best practice and keeping up with industry changes and trends

Communication & Collaboration 

• Collaborates effectively with others to achieve team goals. Regular engagement with Corporate teams, providing feedback to relevant teams on claims trends. Verbal and written client communication is a daily requirement.

Organizational Risk Management

• Keep track of risk parameters, identifying any deviations and reporting them to more senior colleagues. Involves working within established risk management systems.

Regulatory and Compliance Management

• Investigate standard incidents using current regulatory and compliance processes, systems, and procedures, and take action to solve immediate compliance issues. Advise more senior colleagues on more complex problems.

Operational Compliance

• Develop knowledge and understanding of the organization's policies and procedures and of relevant regulatory codes and codes of conduct to ensure own work adheres to those standards.

Personal Capability Building

• Develop own capabilities by participating in assessment and development planning activities as well as formal and informal training and coaching. Develop and maintain an understanding of relevant technology, external regulation, and industry best practices through ongoing education, attending conferences, and reading specialist media.

Role Requirements: Skills, Qualifications and Experience 

• Grade 12/Matric
• Completed medical / allied health Degree, e.g. Nursing, Occupational Therapy, Physiotherapy
• Minimum 2 years clinical experience
• Experience in the Financial Service Industry is advantageous
• Disability Claims assessment experience in a Group Assurance or Risk environment and GAP product knowledge is highly advantageous
• Well developed interpersonal skills
• Strong verbal and written communication skills
• Excellent attention to detail
• Good presentation skills
• Ability to work under pressure to meet deadlines
• Computer literate and proficient in MS Office programmes e.g. Word, powerpoint & Excel
• Have sound analytical and problem solving abilities
• Work effectively with internal and external colleagues and clients to accomplish organisational and team goals
• Enjoy working in a progressive environment

Skills

• Action Planning, Claims Management, Claims Settlement, Data Compilation, Data Controls, Executing Plans, Financial Auditing, Insurance Claims Investigations, Oral Communications, Presenting Solutions

Competencies

• Business Insight
• Collaborates
• Decision Quality
• Drives Results
• Ensures Accountability
• Financial Acumen
• Instills Trust
• Manages Complexity

Education

• NQF Level 5 - Higher, Advance or Occupational Certificate or equivalent

Closing Date

• 30 June 2026