Job Description

Accurate assessment, investigation and validation of long-term insurance claims in accordance with the goals, objectives, processes and standards of the organisation in order to meet customer

These claims may include funeral, death, disability, dread disease and retrenchment claims

Hello Future, GAP Claims Assessor,

Welcome to FNB, the home of the #changeables. We design for the shapeshifters and deliver products and services that make us incredibly proud of people that make it happen.

As part of our team in FR Life Assurance, you will be surrounded by unique talents, diverse minds, and an adaptable environment that lives up to the promise of staying curious. Now’s the time to imagine your potential in a team where experts come together and ignite effective change

Are you someone who can:

• Assess and adjudicate GAP claims in line with policy terms and conditions.
• Apply ICD-10 and CPT coding knowledge to accurately validate medical procedures, diagnoses, and billing.
• Manage claims lifecycle from registration through to finalization within agreed turnaround times.
• Investigate and resolve discrepancies, anomalies, or potential fraud indicators.
• Ensure accurate claim settlements and approvals within delegated authority.
• Collate, analyse, and interpret data to support decision-making.

Customer Experience & Service Delivery

• Deliver customer service excellence aligned with organizational values.
• Build and maintain trusting, long-term relationships with customers and stakeholders.
• Ensure full understanding of customer needs through data and feedback analysis.
• Resolve customer queries and complaints timeously, taking ownership of issues.
• Provide accurate product knowledge and service-related information.
• Collaborate with internal business units, product houses, and stakeholders to drive operational efficiency.

Personal Development & Team Contribution

• Assess own performance against competencies and identify development needs.
• Develop and maintain a personal development plan.
• Share knowledge and contribute to team learning and success.
• Foster a collaborative, inclusive, and high-performance team culture

You will be an ideal candidate if you have:

• Matric (Grade 12) – essential
• NQF Level 5 qualification – advantageous
• 2–4 years’ experience in claims environment, preferably in:
  • GAP or medical claims assessment
  • Medical aid or insurance claims processing
  • Claims call centre

Technical Competencies

• Strong understanding of:
  • ICD-10 diagnostic coding
  • CPT (Current Procedural Terminology) codes
  • Medical billing and tariff structures
• Claims assessment and adjudication expertise

Behavioral Competencies

• Customer-centric mindset
• Strong analytical and problem-solving skills
• Attention to detail and accuracy
• Effective communication and stakeholder management
• Ability to work under pressure and meet deadlines
• Adaptable, curious, and innovative

You will have access to:

• Opportunities to network and collaborate
• A challenging yet growth enabling environment
• Opportunities to innovate

Apply now if you are interested in taking the next step. We look forward to engaging with you!

All appointments will be made in line with FirstRand Group’s Employment Equity plan. The bank supports the recruitment and advancement of individuals with disabilities. In order for us to fulfill this purpose, candidates can disclose their disability information on a voluntary basis. The Bank will keep this information confidential unless we are required by law to disclose this information to other parties.

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Important Closing Date Note

Take note that applications will not be accepted on the below date and onwards, kindly submit applications ahead of the closing date indicated below.

18/06/26