Senior Claims Assessor - Carletonville

Introduction: As the Senior Claims Assessor, you will be reporting to the Team Leader: Senior Claims Assessor. You will be responsible for adjudicating and processing claims in an effective and efficient manner within the prescribed guidelines set out by Rand Mutual Assurance. Description: THE JOB AT A GLANCE As the Senior Claims Assessor, you will be reporting to the Team Leader: Senior Claims Assessor. You will be responsible for adjudicating and processing claims in an effective and efficient manner within the prescribed guidelines set out by Rand Mutual Assurance. WHAT WILL YOU DO? Adjudicate on claims: Adjudicate claims in line with relevant policies, terms and conditions and all other requirements Decide on liability to pay the claims Evaluate claims received and determine requirements i.e. medical reports, Statement of Earnings for adjudication Evaluate and determine requirements for claims to be presented to RMA Medical staff and Technical Committee for decision making Where applicable, refer claims for repudiation Identify potential reinsurance and recoveries Identify fraudulent and suspicious claims Initiate claims investigations and review of investigation reports Authorise Permanent Disablement lumpsums and other transaction as per the authority limits policy. Manage Claims: Manage claims in line with individual targets Review claims in line with processes and limits as set out in RMA guidelines Escalate claims out of defined authority limits to Team Leader Process claims that fall within defined authority Limits Ensure that communication of claims is processed to both employer and employee as set out in the Claims Management Processes Timeously manage workflows and notifications Capture dependents and refer to Team Leader for authorisation where applicable Ensure timeous finalisation of claims calculation\authorisation of disability assessments Process claims within Maximum Medical Improvement and\or prescribed Claims Processing Cycle. Manage Costs: Approve claims for payment within authority limits for Total Temporary Disablement and Permanent Disability lumpsums and where necessary refer to Team Leaders Customer Service: Regularly communicate and liaise verbally and in writing with customers/suppliers/visitors/enquirers and relevant staff Interpret and respond clearly and effectively to spoken requests over the phone or in person, and to verbal or written instructions Manage walk-in queries as and when required Handle customer inquiries both telephonically and by email Provide customers with accurate product and service information in an efficient manner Deal with all customers in a professional and empathetic manner WHAT WILL YOU GET IN RETURN? We offer great opportunities for personal and professional development in a stable company that is 130 years strong. The role comes with a competitive salary package and various benefits. Furthermore, you will be part of a dedicated group of colleagues who value teamwork and collaboration. Turnaround time The shortlisting process will only start once the advert due date has been reached. The time taken to complete this process will depend on how far you progress within the recruitment process and the availability of our managers. Kindly note that should you not receive a response within 21 days, please consider your application unsuccessful. Closing date: 28th October 2025 Our Commitment to transformation: In accordance with the employment equity plan of Rand Mutual Assurance and its employment equity goals and targets, preference may be given, but is not limited, to candidates from under-represented designated groups. Requirements: WHAT YOU'LL BRING TO THE TABLE? Grade 12 qualification/Matric Certificate NQF Level 6 Diploma in a FAIS recognised qualification COIDA in Practice or Insurance Qualification an advantage Legal qualification (Advantageous) FAIS Regulatory Examination (RE5) Minimum 5 years experience within the Insurance industry within a claims environment Knowledge of payroll admin processes Knowledge of COID legislation Knowledge of Claims processing, approval and payment processes would be advantageous Insurance and/or Medical Aid experience would be advantageous

Location: West Rand, Gauteng, ZA

Posted Date: 10/18/2025