Job Description

Job Advert Summary

Responsible for the assessment and management of long-term Sickness, Permanent Incapacity, and Disability claims. The incumbent applies specialist claims expertise, deep process knowledge, and a client-centric approach to deliver high-quality service. The role involves handling complex and technical claims queries and complaints, ensuring superior service experience. Collaboration with the Research & Development team is essential to support cross-functional and broader organisational objectives.

Minimum Requirements

Education:

Degree in Occupational Therapy/Physiotherapy or any relevant clinical qualification

Experience:

5+ years' experience in the insurance industry 4+ years' experience in claims assessment including Income protection, Lump Sum Disability and dread disease Case Management experience (preferred)

Knowledge and Skills:

Must have excellent telephone etiquette Good computer knowledge - MS Outlook, Excel and Word are necessary Ability to work independently as well as being a good team-player with excellent interpersonal skills Logical and analytical Effective time management skills Deadline/target driven, with ability to work under pressure Logical and analytical Excellent report writing and presentation skills

Competencies:

Planning and organizing Attention to detail Client centricity Building and maintaining relationships Resilience Complex problem solving Adapting and responding to change Innovation and Forward Thinking

Duties and Responsibilities

Assess and manage long-term Sickness, Permanent Incapacity, and Disability claims in line with policy and procedural guidelines Review, analyse, and summarise medical documentation to support informed decision-making Evaluate technical aspects of claims, including potential non-disclosure and applicable exclusions Present complex claims to the Medical Officers Committee for further assessment and decision-making Draft comprehensive referral letters to independent specialists and detailed decision letters to members Manage long-term claims by coordinating rehabilitation and return-to-work programs in collaboration with appointed specialists Communicate claims outcomes and future claim requirements to members, ensuring clarity and transparency Manage Arbitration and Ombudsman cases, working closely with relevant stakeholders throughout the complaints process Demonstrate consistent adherence to audit requirements to support compliance and governance standards * Serve as a Subject Matter Expert (SME) by sharing specialist knowledge and providing technical guidance to colleagues and stakeholders