Complex Claims Adjuster

Placements24; South Africa; Remote; ZAR 900,000 - 1,200,000; Full time

Benefits offered by this job

Medical aid

Retirement plan

Life insurance

Career progression

Professional development

Job summary

Placements24 is seeking a seasoned Complex Claims Adjuster for our client, a leading insurance firm, based in Centurion, Gauteng. The role demands analytical prowess to handle high-value, multifaceted claims, with responsibilities spanning investigation, coverage review and settlement decisions.

You will negotiate, manage reserves, and stay abreast of regulatory changes while liaising with policyholders and legal representatives.

Qualifications

• 6+ years of experience handling complex insurance claims.
• Strong analytical, critical thinking and problem-solving skills.
• Superior negotiation and interpersonal abilities.
• Understanding of insurance principles, contracts and claims investigation.
• Litigation management experience is advantageous.
• Bachelor's degree or industry qualification preferred.

Responsibilities

• Investigate, evaluate and negotiate settlement of complex and potentially litigated insurance claims.
• Review policy wordings, endorsements and documentation to determine coverage.
• Gather and analyze evidence including witness statements and expert reports.
• Communicate effectively with policyholders, claimants, legal representations and stakeholders.
• Determine liability and indemnity, ensuring fair claim valuations.
• Approve payments and manage claim reserves efficiently.
• Identify subrogation and salvage opportunities.
• Maintain detailed claim files in line with procedures and audits.
• Stay updated on legal decisions and industry trends affecting claims.
• Provide expert advice to internal teams and external parties on complex claims.

Education

Bachelor's degree

Industry qualification

Tools

Claims software

Microsoft 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.