Senior Life Claims Assessor (Risk-Based)

## When it comes to putting people first, we're number 1. The number 1 Top Employer in South Africa. Certified by the Top Employer Institute 2026. ## Role Purpose/Business Unit: As a Senior Claims and Payments Assessor, you will evaluate and process Death, Critical Illness, Disability, and Incapacity claims through a proactive, risk-based lens. Your primary responsibility is to assess claim validity, manage financial exposure, and mitigate operational risks while ensuring strict adherence to fund rules, regulatory criteria, and statutory compliance. This role requires sharp risk-detection capabilities, excellent analytical skills, and the ability to make defensible, high-value payout decisions under pressure. ## Your responsibilities will include: * Risk-based assessment: Evaluate complex Death, Disability, Incapacity, and Critical Illness claims by identifying, analysing, and mitigating potential financial and fraud risks prior to payout approval. * Payment risk management: Oversee the end-to-end verification of payment releases to ensure accurate disbursements, preventing leakage and ensuring alignment with approved mandates. * FICA & AML compliance: Execute mandatory Financial Intelligence Centre Act (FICA) protocols, ensuring rigorous Customer Due Diligence (CDD) and verification of ultimate beneficial owners before unlocking payments. * Fraud mitigation: Investigate high-risk or suspicious claims, identify politically exposed persons (PEPs), compile detailed risk reports, and escalate suspected money laundering or fraudulent activity to forensic and compliance teams. * SLA and quality compliance: Execute claims processing, central mailbox queries, and complaints handling within strict Service Level Agreements (SLAs) while meeting rigorous quality and volume production standards. * Regulatory governance: Apply fund rules, insurance policies, legislation, and internal controls to maintain a transparent, accountable, and audit-ready claims environment. * Stakeholder liaison: Manage relationships and clear communication with employers, beneficiaries, and service providers to resolve high-risk or sensitive claims queries. * Risk reporting and documentation: Draft formal resolution letters, legal determinations, and weekly/monthly risk-exposure reports, including the documentation of Suspicious Activity Reports (SARs) for management review. ## The ideal candidate for this role will have: * Regulatory Examination 5 (RE5 Representative qualification) is essential or beneficial/advantageous. * Recognised certificate/diploma in Claims Assessment, Long-Term Insurance, Risk Management, or Compliance. (essential or beneficial/advantageous) * Computer literacy: General computer literacy with advanced proficiency across the Microsoft Office Suite, specifically Microsoft Word, Microsoft Excel (for data analysis and reporting), and Microsoft Outlook (for managing high-volume mailbox queries within SLA). ## Core competencies, knowledge and experience: * 2-4 years of experience in Group Schemes administration and risk-based claims assessment. * Compliance knowledge: Practical knowledge of the Financial Intelligence Centre Act (FICA), Anti-Money Laundering (AML) regulations, and Counter-Terrorist Financing (CTF) frameworks within long-term insurance. * Subject matter expertise: Expert understanding of risk benefit portfolios, including Death, Disability, Incapacity, Critical Illness, and Funeral benefits. * Risk acumen: Strong investigative, problem-solving, and decision-making skills with a proven track record of identifying high-risk indicators, cash-routing anomalies, and claim discrepancies. * Organisational awareness: Ability to anticipate how claims decisions impact business risk, reserves, and downstream operational groups. * Execution: Highly organised, target-driven, and capable of managing heavy workloads under pressure without compromising regulatory controls. ## We make an impact by offering: * Enticing incentive programs and competitive benefit packages * Retirement funds, risk benefits, and medical aid benefits * Cell phone and data benefits, advantages fibre connection discounts, and exclusive staff discounts offered in collaboration with partner companies Closing date for Applications: 20 November 2026. The base location for this role is Midrand, Vodacom Campus. The company's approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply. Vodacom is committed to an organisational culture that recognises, appreciates, and values diversity & inclusion.