Claims consultant (Risk - Employee benefits) Permanent REMOTE

Requirements

• 3–5 years' experience in group risk, disability, life insurance, or employee benefits claims

• Demonstrated knowledge of South African group risk products (death, disability, TPD, dread disease, funeral cover)

• Experience with claims management systems, benefit administration platforms

• Strong Excel, data analysis, and reporting capabilities

• Detail-oriented; meticulous in claims validation and documentation

• Strong analytical and problem-solving ability; comfortable interpreting policy wording and claims circumstances

• Client-focused; able to explain complex risk and claims concepts clearly to diverse audiences

• Professional communication skills (written and verbal)

• Ability to work independently and as part of a consulting team

• Proactive; eager to learn and develop technical expertise in employee benefits

• FSP (Financial Services Provider) license or registration with FAIS

• Exposure to claims adjudication, risk assessment, or underwriting

• Knowledge of POPIA, FAIS, RE1 and RE5 and other South African employment and data protection legislation

Duties

• Maintain detailed records; manage client portals and claims tracking systems; ensure compliance with POPIA and regulatory requirements

• Review, query, and validate group life and disability claims submissions; ensure accuracy and policy compliance

• Analyse claims data and utilisation patterns; identify trends and outliers; provide reports and insights to clients and the underwriting team

• Liaise with insurers on claims queries, special requests, and dispute resolution

• Support underwriting and pricing decisions with claims experience data and risk assessments

• Advise clients on group risk benefit design, cover levels, waiting periods, and exclusions to balance affordability with appropriate protection

• Prepare claims and risk-related illustrations, quotations, and technical documentation

As a Claims Consultant – Risk, you will manage and advise on group life and disability claims, risk assessments, and benefit design. Your responsibilities will span claims processing oversight, underwriting support, claims analytics, and strategic advice to clients on optimising their group risk programmes.

You will be a key member of the risk consulting team, working closely with actuaries, account managers, and clients to ensure claims are handled efficiently, accurately, and in line with policy terms. Your insights on claims trends will inform better benefit design and pricing negotiations with insurers.

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Originally posted on Himalayas