Senior Claims Adjuster - Complex Claims

Placements24; Kimberley; Hybrid; CAD 126,000 - 182,000; Full time

Benefits offered by this job

Fully remote work arrangement

Professional development opportunities

Comprehensive medical insurance

Job summary

Placements24 is seeking a Senior Claims Adjuster for a fully remote role within South Africa. You will manage complex, high-value claims across multiple lines, including injury and property, with a focus on fair outcomes and adherence to policy terms.

The role requires 6+ years of claims experience, advanced investigative skills, and the ability to mentor junior adjusters while collaborating with legal counsel as needed. A proactive, detail-oriented approach is essential.

Qualifications

• 6+ years of experience handling complex or large-loss insurance claims.
• Strong knowledge of insurance policies, investigations, and legal principles.
• Excellent analytical, negotiation, and conflict-resolution skills.
• Clear written and verbal communication with diverse stakeholders.

Responsibilities

• Investigate, evaluate, and negotiate complex/high-value claims.
• Interpret policy wordings, determine coverage, assess liability.
• Conduct damages assessments with possible expert reports and site inspections.
• Communicate with policyholders, legal representatives, and witnesses.

Skills

Claims investigation

Negotiation

Policy interpretation

Communication

Mentoring

Education

ACII

CIP

Tools

Claims software

Job description

About the Role

Our client, a premier insurance provider, is seeking a highly experienced Senior Claims Adjuster to manage complex claims. This position is designed to be fully remote, allowing you to work from any location within South Africa. As a Senior Claims Adjuster, you will be responsible for the investigation, evaluation, and negotiation of significant and intricate insurance claims across various lines of business, including property, liability, and commercial. Your expertise in claim assessment, policy interpretation, and resolution will be critical in ensuring fair outcomes for policyholders and safeguarding the company's financial interests. This role offers a challenging yet rewarding opportunity to apply your advanced skills in a flexible, remote-first work environment. We value accuracy, integrity, and a proactive approach to claim resolution.

Key Responsibilities

• Investigate, evaluate, and negotiate complex and high-value insurance claims thoroughly and efficiently.


• Interpret policy wordings, determine coverage, and assess liability in accordance with policy terms and legal requirements.


• Conduct detailed assessments of damages and losses, potentially involving expert reports and site inspections.


• Communicate effectively with policyholders, legal representatives, witnesses, and other involved parties throughout the claims process.


• Prepare comprehensive claims reports, documenting findings, analysis, and settlement recommendations.


• Manage a caseload of complex claims, ensuring timely progress and resolution while maintaining high-quality standards.


• Identify potential subrogation or salvage opportunities.


• Collaborate with legal counsel on litigated claims as required.


• Stay informed about industry best practices, relevant legislation, and emerging claims trends.


• Mentor junior adjusters by providing guidance and sharing expertise on complex claim scenarios.

Requirements

• A minimum of 6 years of experience as a Claims Adjuster, with a significant focus on complex or large-loss claims within the insurance industry.


• In-depth knowledge of insurance policies, claims investigation techniques, and legal principles.


• Exceptional analytical, negotiation, and conflict-resolution skills.


• Strong written and verbal communication skills, capable of clearly articulating complex issues.


• Proficiency in claims management software and digital tools.


• Ability to work independently and manage a demanding caseload effectively in a remote setting.


• Relevant professional designations (e.g., ACII, CIP) are highly advantageous.


• A proven track record of accurate claim assessment and fair resolution.


• Strong ethical compass and commitment to professional conduct.

Benefits

• Competitive salary package commensurate with experience and expertise.


• Fully remote working arrangement offering excellent work-life flexibility.


• Opportunities for professional development, advanced certifications, and continuous learning.


• Comprehensive medical, dental, and vision insurance.


• Generous paid time off and holiday allowances.


• Access to advanced claims management technology and resources.


• Supportive team environment with regular virtual collaboration.


• Potential for career advancement within the insurance sector.