Claims Adjuster - Complex Claims

Placements24; Mbombela (Nelspruit); On-site; ZAR 420,000 - 660,000; Full time

Benefits offered by this job

Medical aid

Provident fund

Life assurance

Career development

Job summary

Placements24 on behalf of a leading insurer in Nelspruit seeks an experienced Claims Adjuster to manage complex claims, determine liability, and negotiate settlements. The role requires strong analytical skills and thorough investigations to deliver fair, timely resolutions.

You will work with a team to assess coverage, liaise with legal and engineering experts, and ensure compliance with South African regulations while delivering excellent customer service.

Qualifications

• Minimum of 5 years in claims adjusting, handling complex and large-loss claims.
• In-depth knowledge of insurance principles and policy wordings.
• Familiarity with South African insurance laws and regulations.

Responsibilities

• Investigate, evaluate, and adjudicate complex insurance claims.
• Determine coverage and liability based on policy terms.
• Conduct site inspections and gather documentation.
• Interview claimants, witnesses, and relevant parties.
• Negotiate settlements and manage reserves within authority.
• Liaise with legal counsel, engineers, and experts as needed.
• Prepare detailed status reports and recommendations.
• Ensure compliance with policies and regulatory requirements.
• Provide excellent customer service throughout the claims process.

Skills

Analytical thinking

Negotiation

Communication skills

Problem solving

Decision making

Education

Tertiary qualification (Law/Business/Risk Management)

Tools

Claims management software

Job description

About the Role

Our client, a prominent insurer, is seeking an experienced and adept Claims Adjuster to manage complex claims within their **Nelspruit** branch. This role demands a sharp, analytical mind capable of assessing intricate insurance claims, determining liability, negotiating settlements, and ensuring fair and timely resolution. You will handle claims that require in-depth investigation and specialized knowledge, often involving significant financial value or legal complexities. The ideal candidate will possess a strong understanding of various insurance policies, excellent negotiation skills, and a commitment to providing exceptional customer service. This is a challenging and rewarding opportunity to join a leading insurance provider in **Nelspruit**.

Key Responsibilities

• Investigate, evaluate, and adjudicate complex insurance claims (e.g., commercial property damage, liability, large loss motor).
• Determine coverage and liability based on policy terms and conditions.
• Conduct thorough site inspections and gather necessary documentation and evidence.
• Interview claimants, witnesses, and other relevant parties to obtain information.
• Negotiate settlements with claimants and their representatives in a fair and efficient manner.
• Manage claim reserves and authorize payments within established authority limits.
• Liaise with legal counsel, engineers, and other experts as needed.
• Prepare detailed reports on claim status, findings, and recommendations.
• Ensure claims handling complies with company policies, procedures, and regulatory requirements.
• Provide excellent customer service throughout the claims process.

Requirements

• Relevant tertiary qualification (e.g., Law, Business, Risk Management) or equivalent professional experience.
• Minimum of 5 years of experience as a Claims Adjuster, with a proven ability to handle complex and large-loss claims.
• In-depth knowledge of insurance principles, policy wordings, and claims investigation techniques.
• Strong analytical, decision-making, and problem-solving skills.
• Excellent negotiation, communication, and interpersonal skills.
• Proficiency in claims management software.
• Familiarity with **South African** insurance laws and regulations.
• Professional designation such as an Associate in Claims (AIC) or Chartered Property Casualty Underwriter (CPCU) is advantageous.
• Ability to manage a caseload effectively and meet deadlines in **Nelspruit**.
• High degree of integrity and commitment to ethical practices.

Benefits

• Our client offers a competitive salary, an excellent benefits package including comprehensive medical aid, a provident fund, and life assurance.
• Opportunities for professional development, ongoing training, and career advancement within the company are readily available.