Technical Claims Assessor

7 days ago

Durban, South Africa Nedbank Full time

**Job Classification**
- Job Requisition: 140914
- TA Specialist: Refilwe Falatsi
- Closing Date: 18 July 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/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
- Behavioural Competencies
- Customer Orientation
- Collaborating
- Monitoring Information
- Decision Making
- Initiating Action
- Work Standards
- Planning and Organizing
- Communication
- **_Please contact the Nedbank Recruiting Team at +27 860 555 566_

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