Specialist - Major Claims (Death & Critical Illness)

It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030.

And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business.

• Review claims documentation, policy coverage, medical evidence, and loss details to determine claim validity, liability, and entitlement in accordance with Company guidelines and delegated authority.

• Assess, review, investigate, approve and process Major Claims (Death and Critical Illness) accurately and timely, applying sound technical judgment and appropriate risk controls.

• Utilize digital claims systems, workflow tools, and data dashboards to manage claim assessments, monitor turnaround time and ensure adherence to service level and quality benchmarks.

• Leverage available automation and AI-enabled tools to enhance assessment efficiency, consistency, and accuracy

• Liaise with Medical Advisors to obtain clinical guidance and clarification where required, ensuring informed and well supported claim decisions.

• Perform effective suspense management, follow up on outstanding requirements, and liaise with Finance and relevant stakeholders to ensure timely and accurate claim payments.

• Actively discuss, document, and escalate complex or disputed claims to senior assessors or management for guidance and resolution, supported by clear analysis and recommendations.

• Contribute to continuous process improvement initiatives by identifying operational inefficiencies, recurring issues, and improvement opportunities within Major Claims workflows.

• Participate in innovation initiatives (e.g. system enhancements, pilot tools, process simplification), providing user feedback and supporting adoption at the operational level.

• Support knowledge sharing and capability building within the team by sharing best practices, lessons learned and updates on process or system changes.

• Perform other tasks and responsibilities as assigned to meet operational requirements and evolving business needs.

• Education qualification in Biomedical, Biology, Medicine, Nursing or related fields

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.