Insurance Claims Assessor

Placements24; George; Hybrid; ZAR 360,000 - 540,000; Full time

Benefits offered by this job

Hybrid work arrangement

Medical aid

Retirement fund contributions

Paid leave and company holidays

Wellness programs

Travel expense reimbursement

Career progression opportunities

Job summary

Placements24 in the Western Cape is seeking an Insurance Claims Assessor for a hybrid role based in George. You will investigate, evaluate, and negotiate claims, using policy knowledge to determine fair settlements while delivering excellent customer service.

You will collaborate with legal, recovery, and actuarial teams, maintain detailed records, and conduct site visits in George as needed. The role emphasizes integrity and professional standards in a dynamic insurance environment.

Qualifications

• Minimum of 3 years of experience in insurance claims assessment or related field.
• Tertiary qualification in Insurance, Law, or Business preferred.
• Strong understanding of insurance principles, policy wordings, and claims handling procedures.
• Excellent analytical, problem-solving, and decision-making skills.
• Exceptional communication, negotiation, and interpersonal skills.
• Proficiency in claims management software and Microsoft Office Suite.
• Ability to work in a hybrid environment with in-office and remote responsibilities.
• Valid driver's license and willingness to undertake site visits in George.

Responsibilities

• Investigate insurance claims by gathering policy details, incident reports, and witness statements.
• Assess validity and extent of damages based on policy terms.
• Conduct inspections of damaged property or review medical reports as applicable.
• Negotiate settlements with claimants, ensuring fairness and adherence to policy limits.
• Communicate with policyholders, legal representatives, and other parties throughout the process.
• Maintain accurate records in the claims management system.
• Identify potential fraudulent claims for further investigation.
• Provide clear explanations of policy coverage and claim outcomes to policyholders.
• Collaborate with legal, recovery, and actuarial teams to resolve complex claims.
• Ensure compliance with insurance laws, regulations, and company policies.

Skills

Analytical skills

Problem solving

Decision making

Communication

Negotiation

Interpersonal skills

Education

Tertiary qualification in Insurance/Law/Business

Tools

Claims software

Microsoft Office

Job description

About the Role

Our client, a prominent player in the South African insurance sector, is looking for a meticulous and empathetic Insurance Claims Assessor to manage a diverse portfolio of claims. This role is essential for ensuring that our client provides fair and efficient claim settlements, upholding their commitment to customer satisfaction and trust. While the position offers a hybrid work model, allowing for a balance between in-office collaboration and remote flexibility, it requires a strong presence in our George office for critical team interactions and site visits when necessary. You will be responsible for investigating, evaluating, and negotiating claims, making informed decisions based on policy coverage and evidence. The ideal candidate will possess exceptional analytical skills, a deep understanding of insurance policies, and a commitment to providing outstanding service to clients during what can be a challenging time for them. This is a fantastic opportunity to contribute to a respected organization while developing your expertise in claims management within the vibrant Western Cape region. We are seeking individuals who are proactive, detail-oriented, and capable of managing their caseload effectively, ensuring timely and accurate resolutions. The role demands a high degree of integrity and professionalism in all dealings, fostering long-term relationships with policyholders and contributing to the overall success of the claims department. Embrace a role where your analytical skills and customer service orientation make a real difference.

Key Responsibilities

• Investigate insurance claims by gathering relevant information, including policy details, incident reports, and witness statements.
• Assess the validity and extent of damages or losses based on policy terms and conditions.
• Conduct thorough inspections of damaged property or review medical reports as applicable to the claim type.
• Negotiate settlements with claimants, ensuring fairness and adherence to policy limits.
• Communicate effectively with policyholders, legal representatives, and other involved parties throughout the claims process.
• Maintain accurate and detailed records of all claims activities, decisions, and communications in the claims management system.
• Identify potential fraudulent claims and identify them for further investigation according to company procedures.
• Provide clear explanations of policy coverage and claim outcomes to policyholders.
• Collaborate with internal departments such as legal, recovery, and actuarial teams to resolve complex claims.
• Ensure compliance with all relevant insurance laws, regulations, and company policies.

Requirements

• Minimum of 3 years of experience in insurance claims assessment or a closely related field.
• Relevant tertiary qualification in Insurance, Law, Business, or a related discipline is preferred.
• Strong understanding of insurance principles, policy wordings, and claims handling procedures.
• Excellent analytical, problem-solving, and decision-making skills.
• Exceptional communication, negotiation, and interpersonal skills.
• Proficiency in claims management software and Microsoft Office Suite.
• Ability to work effectively in a hybrid environment, balancing remote and in-office responsibilities.
• High level of integrity, attention to detail, and commitment to customer service.
• Valid driver's license and willingness to undertake occasional site visits within the George area.
• Ability to manage a caseload efficiently and meet deadlines.

Benefits

• Competitive salary package reflecting your experience and expertise.
• Medical aid and retirement fund contributions.
• Opportunities for continuous professional development and training.
• A supportive and collaborative team environment.
• Hybrid work arrangement offering flexibility.
• Paid leave and company holidays.
• Access to employee wellness programs.
• Career progression opportunities within a growing organization.
• Reimbursement for travel expenses related to claim assessments.
• Regular performance reviews with clear feedback and development plans.