Disability Claims Assessor

SUMMARY:
Group Benefits Disability Claims Assessor

POSITION INFO:

Summary:

The Disability Claims Assessor is responsible for accurately assessing, investigating, and managing long-term insurance claims, including disability and critical illness claims. This role requires strong analytical skills, attention to detail, and the ability to engage with various stakeholders to ensure fair and efficient claim outcomes. The ideal candidate will have experience in Group Risk claims assessment and a passion for vocational rehabilitation.

What to Expect:

• Accurately assess, investigate, and manage long-term insurance claims, including disability and critical illness claims
• Prepare draft minutes for the Claims Management Committee (CMC), outlining assessment findings and reasoning
• Assist in organizing and preparing for weekly CMC meetings as required
• Liaise with brokers, employers, and members to gather necessary information and provide updates
• Actively present claims and participate in CMC meetings
• Follow up on action items from CMC meetings, liaising with reinsurers and other stakeholders as necessary to implement decisions and manage claims
• Coordinate with appropriately qualified independent service providers for external examinations and appointments
• Draft clear and concise letters communicating assessment decisions
• Ensure a strong understanding of the claims processing and payment procedures
• Lead and contribute to key projects within the claims team, including vocational rehabilitation and early intervention initiatives
• Respond to stakeholder queries efficiently and professionally within established turnaround times
• Provide support to service providers, offering clarification and assistance as needed
• Maintain timely, accurate, and complete data entries on all systems
• Adhere to established procedures and workflows, ensuring compliance with turnaround times
• Deliver high-quality service to both internal and external stakeholders, safeguarding their interests
• Ensure that claim assessments align with the company’s values and standards of decision-making
• Foster a collaborative and supportive team environment

What You'll Bring:

Qualifications and Experience

• Matric or equivalent qualification
• Relevant Medical Qualification (e.g., Occupational Therapy, Physiotherapy, Nursing, etc.)
• Minimum of 2 years’ experience in assessing Group Risk claims, with a strong background in disability claims. Exposure to lump sum claims such as Life, Capital Disability, and Critical Illness is an advantage

Competencies

• Excellent interpersonal and communication skills, both verbal and written
• Strong understanding of Long-Term Insurance and Group Risk products
• Familiarity with Vocational Rehabilitation and the implementation of related programs
• Passion for improving processes, particularly those related to Vocational Rehabilitation
• Ability to work independently and as part of a collaborative team
• Strong time-management skills with the ability to meet deadlines and adhere to strict turnaround times
• Ability to thrive under pressure, maintaining both speed and accuracy
• Meticulous attention to detail and effective data management skills
• Strong problem-solving abilities with a pragmatic approach
• Highly self-motivated, proactive, and focused
• Commitment to maintaining client confidentiality
• Strong ethical standards and integrity in all actions
• Willingness to challenge the status quo and strive for excellence
• Ability to drive results and deliver on commitments
• Organized and detail-oriented with a passion for continuous learning and collaboration