Insurance Claims Assessor

Placements24; Kempton Park; Hybrid; ZAR 320,000 - 520,000; Full time

Benefits offered by this job

Medical aid

Provident fund

Hybrid work model

Employee wellness programs

Job summary

Placements24 is assisting a reputable insurer in recruiting an Insurance Claims Assessor for a hybrid role in Gauteng. You will investigate, evaluate and settle claims, determining liability in line with policy terms while delivering excellent service.

You will collaborate with policyholders, claimants and third parties, maintain precise records, and identify potential fraud. The ideal candidate has solid claims experience, strong analytical skills and effective communication in a dynamic team

Qualifications

• Proven experience as a Claims Assessor or in a similar insurance claims handling role.
• Solid understanding of insurance policies, legal principles, and claims investigation techniques.
• Excellent analytical, critical thinking and problem-solving skills.
• Strong negotiation and conflict-resolution abilities.
• Exceptional communication and interpersonal skills, with the ability to handle sensitive situations with empathy.

Responsibilities

• Investigate insurance claims by gathering all necessary information, including policy details, incident reports, and witness statements.
• Assess the validity and value of claims, determining coverage and liability based on policy terms.
• Communicate effectively with policyholders, claimants, and third parties to explain coverage, processes, and decisions.
• Negotiate settlements with claimants and their representatives.
• Appoint and manage external adjusters and repair services when necessary.
• Maintain accurate and detailed records of all claim activities and decisions in the claims management system.
• Identify potential cases of fraud and elevate them for further investigation.
• Ensure compliance with company policies, procedures, and regulatory requirements.
• Contribution to improving claims handling processes and customer satisfaction.
• Participate in team meetings and provide insights on claim trends and best practices.

Skills

Claims assessment

Analytical skills

Negotiation

Communication

Fraud detection

Insurance policies

Education

Degree or diploma in a relevant field

Tools

Claims management software

Job description

About the Role

Our client, a reputable insurer, is seeking a diligent and analytical Insurance Claims Assessor to join their team based in Tembisa, Gauteng.

This hybrid role offers the flexibility of working both from home and in the office, allowing for collaboration and focused individual work. The Claims Assessor will be responsible for investigating, evaluating, and settling insurance claims efficiently and fairly. You will be instrumental in determining the extent of liability and ensuring that claims align with policy terms and conditions. This position requires a keen eye for detail, strong communication skills, and a deep understanding of insurance processes. Join a company that is dedicated to providing excellent customer service and upholding integrity in every claim handled. The successful candidate will contribute to maintaining customer satisfaction and protecting the company's assets. We value expertise and offer a supportive environment for professional growth.

Key Responsibilities

• Investigate insurance claims by gathering all necessary information, including policy details, incident reports, and witness statements.
• Assess the validity and value of claims, determining coverage and liability based on policy terms.
• Communicate effectively with policyholders, claimants, and third parties to explain coverage, processes, and decisions.
• Negotiate settlements with claimants and their representatives.
• Appoint and manage external adjusters and repair services when necessary.
• Maintain accurate and detailed records of all claim activities and decisions in the claims management system.
• Identify potential cases of fraud and elevate them for further investigation.
• Ensure compliance with company policies, procedures, and regulatory requirements.
• Contribution to improving claims handling processes and customer satisfaction.
• Participate in team meetings and provide insights on claim trends and best practices.

Requirements

• Proven experience as a Claims Assessor or in a similar insurance claims handling role.
• Solid understanding of insurance policies, legal principles, and claims investigation techniques.
• Excellent analytical, critical thinking and problem-solving skills.
• Strong negotiation and conflict-resolution abilities.
• Exceptional communication and interpersonal skills, with the ability to handle sensitive situations with empathy.
• Proficiency in claims management software and standard office applications.
• A degree or diploma in a relevant field is preferred but not essential if extensive experience is demonstrated.
• Ability to work independently and as part of a hybrid team managing workload effectively.
• Strong ethical conduct and commitment to fairness.
• Must be detail-oriented and organised.

Benefits

• Competitive salary package.
• Medical aid and provident fund contributions.
• Opportunities for professional development and further training.
• Hybrid work model offering work-life balance.
• A supportive and team-oriented work environment.
• Employee wellness programs.
• Potential for career advancement within the company.