Complex Claims Adjuster

Placements24; Centurion; On-site; ZAR 900,000 - 1,300,000; Full time

Job summary

Placements24 is actively seeking a seasoned Complex Claims Adjuster based in Centurion, Gauteng. The role requires managing high-value, potentially litigious insurance claims with meticulous attention to policy provisions and regulatory compliance.

You will investigate, evaluate, and negotiate settlements, review policy wordings, gather evidence, and communicate effectively with all stakeholders to ensure fair and accurate resolutions.

Qualifications

• Minimum 6 years of demonstrable experience handling complex insurance claims.
• Strong understanding of insurance principles, contract law, and investigation techniques.
• Experience with litigation management is advantageous.

Responsibilities

• Investigate, evaluate, and negotiate settlement of complex and potentially litigated claims.
• Review policy wordings and endorsements to determine coverage.
• Gather and analyze evidence including statements and expert reports.
• Communicate with policyholders, claimants, legal representations, and stakeholders.
• Determine liability and indemnity, ensuring fair claim valuations.
• Approve payments and manage claim reserves.

Skills

Complex claims

Analytical thinking

Negotiation

Insurance concepts

Stakeholder communication

Education

Bachelor's degree or equivalent

Tools

Claims software

MS Office

Job description

About the Role

Our client, a leading insurance firm, is actively seeking a seasoned Complex Claims Adjuster to join their expanding operations based in Centurion, Gauteng . This role is designed for a highly analytical and detail-oriented professional adept at managing multifaceted and high-value insurance claims. The successful candidate will be responsible for investigating, evaluating, and resolving claims with a focus on fairness, accuracy, and efficiency, while strictly adhering to policy provisions and regulatory frameworks. This is a challenging yet rewarding position that offers the opportunity to work on significant cases and contribute to the overall success of the claims division. You will be joining a team that prides itself on its expertise and commitment to client satisfaction.

Key Responsibilities

• Investigate, evaluate, and negotiate settlement of complex and potentially litigated insurance claims.
• Conduct thorough reviews of policy wordings, endorsements, and relevant documentation to determine coverage.
• Gather and analyze evidence, including witness statements, expert reports, and damage assessments.
• Communicate effectively and empathetically with policyholders, claimants, legal representations, and other stakeholders throughout the claims process.
• Determine liability and indemnity, ensuring fair and accurate claim valuations.
• Approve payments and manage claim reserves efficiently.
• Identify and manage subrogation and salvage opportunities.
• Maintain detailed and accurate claim file documentation, adhering to internal procedures and audit requirements.
• Stay abreast of relevant legal decisions, industry trends, and legislative changes impacting claims handling.
• Provide expert advice and support to internal teams and external parties on complex claims matters.

Requirements

• A relevant bachelor's degree or industry-specific professional qualification is preferred.
• A minimum of 6 years of demonstrable experience in handling complex insurance claims, across multiple lines of business if possible.
• A strong understanding of insurance principles, contract law, and claims investigation techniques.
• Exceptional analytical, critical thinking, and problem-solving skills.
• Superior negotiation, communication, and interpersonal skills.
• Proficiency in using claims management software and Microsoft Office Suite.
• Ability to manage a demanding caseload and prioritize effectively in a dynamic environment.
• High level of integrity, professionalism, and ethical conduct.
• Experience with litigation management is advantageous.

Benefits

Our client offers a highly competitive salary package, reflecting the seniority and complexity of the role, plus potential performance bonuses. Comprehensive benefits include excellent medical aid coverage, a substantial retirement savings plan, and life insurance. Opportunities for continuous professional development, advanced training programs, and career progression within a leading insurance company are readily available. The working environment in Centurion is professional, supportive, and fosters collaboration. Enjoy access to modern office facilities and a commitment to employee well-being and work-life integration. This is an excellent career move for a seasoned claims professional.