Good communication and interpersonal skills
enabling you to build strong client relationships. Strong follow-up and coordination abilities
ensuring tasks are completed efficiently. Basic knowledge of the tender process is an added advantage
but we're committed to providing the necessary training.
Work Ethic: Ability to work independently and meet deadlines
demonstrating your commitment to delivering results.
Independently assess complex claims by applying strong technical judgment, policy interpretation, and medical understanding to ensure fair and accurate claim outcomes.
Leverage digital tools, rules engines, and available automation outputs to enhance assessment efficiency, while exercising human judgment for cases requiring interpretation, exceptions, or escalation.
Analyze medical reports, invoices, and supporting documentation to validate claim eligibility, identify inconsistencies, and determine appropriate claim decisions in line with policy terms and exclusions.
...
Perform end‑to‑end FWA investigations in accordance with established investigation frameworks, governance standards and confidentiality requirements
Identify, analyze and assess suspicious or potentially fraudulent claims by reviewing claims documentation and interpreting transactional, behavioral and historical claims data
Apply risk‑based investigation techniques to prioritize cases, balancing investigation depth, timeliness and potential financial or reputational impact
...
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.
...
Perform end‑to‑end FWA investigations in accordance with established investigation frameworks, governance standards and confidentiality requirements
Identify, analyze and assess suspicious or potentially fraudulent claims by reviewing claims documentation and interpreting transactional, behavioral and historical claims data
Apply risk‑based investigation techniques to prioritize cases, balancing investigation depth, timeliness and potential financial or reputational impact
...
Policy & Governance: Support the implementation and maintenance of the Operational Risk and TPRM governance frameworks to ensure robust policy compliance.
Risk Oversight: Review, challenge, and report on the organization’s operational risk profile, ensuring alignment with third-party risk appetite.
Incident Monitoring: Monitor material incidents, key risk indicators (KRIs), and control weaknesses to proactively mitigate emerging operational and vendor risks.
...