Claims Specialist - Large Losses & Complex Claims

Ashley Kruth; Johannesburg; On-site; ZAR 600,000 - 900,000; Full time

Job summary

A leading insurer in Gauteng seeks an experienced Claims Specialist to manage high-value commercial claims from notification to final settlement. The role requires strong technical ability in policy interpretation, liability assessment, and coverage determination.

You will review technical reports, engage with brokers, attorneys, and loss adjusters, provide guidance on complex claims, ensure regulatory compliance, and uphold governance standards; RE5 qualification is essential and experience

Qualifications

• 5-10 years' experience in short-term insurance claims.
• Proven experience handling large losses and complex commercial claims.
• Experience managing claims valued at R1 million+.
• Strong exposure to commercial property, engineering, liability, business interruption, and motor/fleet claims.
• RE5 qualification essential.
• Relevant insurance, legal, risk management, or commerce qualification advantageous.
• Strong technical drafting, analytical, negotiation, and stakeholder management skills.

Responsibilities

• Manage large-loss and complex claims, ensuring fair and accurate outcomes.
• Assess policy coverage, exclusions, endorsements, and liability exposure.
• Review technical reports, repair quotations, business interruption calculations, and loss-adjuster findings.
• Draft coverage opinions, repudiation letters, and settlement recommendations.
• Engage with brokers, attorneys, loss adjusters, engineers, and other stakeholders.
• Provide technical guidance and recommendations on complex claims matters.

Skills

Claims handling

Policy interpretation

Liability assessment

Negotiation

Stakeholder management

Technical drafting

Regulatory compliance

Education

RE5 qualification

Insurance/legal/risk qualification advantageous

Job description

Permanent

CPT003774

Insurance

Gauteng , JHB - Southern Suburbs

Annually Cost To Company (Market related)

A leading insurer is seeking an experienced Claims Specialist to manage high-value, complex commercial claims from notification through to final settlement. This role is ideal for a technically strong insurance professional with extensive experience in policy interpretation, liability assessment, coverage determination, and settlement negotiation across multiple classes of business.

Key Responsibilities:

• Manage large-loss and complex claims, ensuring fair and accurate outcomes.
• Assess policy coverage, exclusions, endorsements, and liability exposure.
• Review technical reports, repair quotations, business interruption calculations, and loss-adjuster findings.
• Draft coverage opinions, repudiation letters, and settlement recommendations.
• Engage with brokers, attorneys, loss adjusters, engineers, and other stakeholders.
• Provide technical guidance and recommendations on complex claims matters.
• Ensure compliance with regulatory, governance, and company requirements. [Claims Spe...lex Claims | PDF]

Requirements:

• 5-10 years' experience in short-term insurance claims.
• Proven experience handling large losses and complex commercial claims.
• Experience managing claims valued at R1 million+.
• Strong exposure to commercial property, engineering, liability, business interruption, and motor/fleet claims.
• RE5 qualification essential.
• Relevant insurance, legal, risk management, or commerce qualification advantageous.
• Strong technical drafting, analytical, negotiation, and stakeholder management skills.

What We're Looking For:

A detail-oriented and commercially minded claims professional who can confidently navigate technically complex matters, make sound claims decisions, and communicate effectively with both internal and external stakeholders. The successful candidate will demonstrate excellent judgement, strong problem-solving abilities, and a commitment to delivering exceptional service while maintaining technical excellence.

Please note only shortlisted candidates will be contacted