Senior PI Claims Assessor

About the role

The Senior PI Claims Assessor is responsible for assessing and managing long‑term sickness, permanent incapacity and disability claims. The role requires specialist claims expertise, deep process knowledge and a client‑centric approach to deliver high‑quality service.

Key responsibilities

• Assess and manage long‑term sickness, permanent incapacity and disability claims in line with policy and procedural guidelines.
• Review, analyse and summarise medical documentation to support informed decision‑making.
• Evaluate technical aspects of claims, including potential non‑disclosure and applicable exclusions.
• Present complex claims to the Medical Officers Committee and draft referral and decision letters.
• Coordinate rehabilitation and return‑to‑work programmes with appointed specialists.
• Communicate outcomes and future claim requirements to members clearly and transparently.
• Manage arbitration and ombudsman cases and ensure compliance with audit requirements.
• Act as a subject‑matter expert, sharing specialist knowledge and providing technical guidance to colleagues.

Required profile

• Degree in Occupational Therapy, Physiotherapy or a relevant clinical qualification.
• 5+ years’ experience in the insurance industry, including 4+ years in claims assessment for income protection, lump‑sum disability and dread disease.
• Case management experience preferred.
• Excellent telephone etiquette and strong interpersonal skills.
• Ability to work independently and as part of a team, with strong analytical and time‑management abilities.

Required skills

• Proficiency with MS Outlook.
• Proficiency with Microsoft Excel.
• Proficiency with Microsoft Word.