Claims Assessor Specialist

Placements24; Cape Town; On-site; ZAR 350,000 - 520,000; Full time

Benefits offered by this job

Health insurance

Retirement planning

Professional development

Career progression

Company vehicle for field work

Job summary

Placements24 in Cape Town seeks a highly skilled Claims Assessor Specialist to manage and resolve complex insurance claims efficiently. You will investigate claims, determine coverage, negotiate settlements, and ensure compliant processing while maintaining client satisfaction.

The role requires a Diploma in Insurance or Law, 5 years’ experience, and proficiency with claims software and MS Office; occasional field investigations may be required.

Qualifications

• Relevant tertiary qualification in Insurance, Law or related field.
• Minimum 5 years’ experience as a Claims Assessor or Adjuster.
• Experience handling complex claims across insurance lines.
• Solid understanding of SA insurance law, regulations, and procedures.
• Strong analytical and problem-solving abilities with attention to detail.

Responsibilities

• Investigate, evaluate, and adjudicate a variety of claims (e.g., motor, property, liability).
• Interpret policy wordings and assess coverage eligibility for each claim.
• Conduct investigations, interview claimants/witnesses, gather evidence, review docs.
• Negotiate settlements with claimants, policyholders and legal reps.
• Ensure timely and accurate processing of payments and reserves.
• Manage a caseload of claims, prioritising to meet deadlines and standards.
• Identify fraud indicators and escalate suspicious cases.
• Maintain clear claim file documentation and communication records.
• Provide exceptional customer service throughout the claims process.
• Stay updated on SA legislation, best practices, and claims trends.

Skills

Analytical thinking

Negotiation

Communication

Interpersonal skills

Time management

Education

Diploma in Insurance

Diploma in Law

Tools

Claims management software

MS Office

Job description

About the Role

Our client is a reputable insurance firm based in the vibrant city of Cape Town , Western Cape, seeking a highly skilled Claims Assessor Specialist. This role is crucial for managing and resolving complex insurance claims efficiently and fairly. You will be responsible for investigating claims, determining coverage, negotiating settlements, and ensuring compliance with company policies and legal requirements. The successful candidate will possess excellent investigative skills, a keen eye for detail, and a strong understanding of insurance law and practices within South Africa . This is an excellent opportunity to advance your career in the insurance sector, contributing to client satisfaction and the company's reputation for integrity and prompt service delivery in Cape Town .

Key Responsibilities

• Investigate, evaluate, and adjudicate a variety of insurance claims (e.g., motor, property, liability).
• Interpret policy wordings and assess coverage eligibility for each claim.
• Conduct thorough investigations, including interviewing claimants and witnesses, gathering evidence, and reviewing documentation.
• Negotiate settlements with claimants, policyholders, and legal representatives.
• Ensure timely and accurate processing of claims payments and reserves.
• Manage a caseload of claims, prioritizing effectively to meet deadlines and service standards.
• Identify potential fraud indicators and elevate suspicious cases for further investigation.
• Maintain clear and concise claim file documentation and communication records.
• Provide exceptional customer service throughout the claims process.
• Stay updated on relevant legislation, industry best practices, and claims trends.

Requirements

• A relevant tertiary qualification (e.g., Diploma in Insurance, Law, or a related field).
• Minimum of 5 years of experience as a Claims Assessor or Adjuster.
• Demonstrated expertise in handling complex claims across various insurance lines.
• Solid understanding of South African insurance law, regulations, and claims procedures.
• Strong analytical and problem-solving skills with meticulous attention to detail.
• Excellent negotiation, communication, and interpersonal skills.
• Proficiency in claims management software and MS Office.
• Ability to work under pressure and manage multiple priorities effectively.
• A valid driver's license and willingness to travel occasionally for investigations.
• Commitment to ethical conduct and professional standards.

Benefits

• Competitive salary package with potential for performance-based incentives.
• Comprehensive health insurance and retirement planning benefits.
• Opportunities for professional development and specialized training.
• A stable and supportive work environment in a well-established company.
• Work from the beautiful city of Cape Town , Western Cape.
• Company vehicle may be provided for field investigations.
• Employee assistance programs for well-being support.
• Annual performance reviews and career progression pathways.
• Access to state-of-the-art claims management systems.
• Pension fund contribution.