Insurance Claims Handler (Complex Cases)

Placements24; LegKraal Gate; Híbrido; ZAR 320.000 - 440.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Hybrid working arrangements

Medical aid and retirement fund

Professional development opportunities

Descripción de la vacante

Placements24 is seeking an experienced Insurance Claims Handler based in Mahikeng, North West. The role focuses on managing complex claims, thorough investigations, and fair settlements, with a hybrid work model balancing on-site and remote work.

The ideal candidate has 4+ years in complex claims handling, strong policy interpretation, and excellent negotiation and communication skills. Hybrid collaboration with legal and loss adjusting teams is essential for success.

Formación

• Minimum 4 years of experience as an Insurance Claims Handler.
• Ability to analyze and interpret complex policy documents.
• Strong negotiation and communication skills.
• Experience in hybrid work environments (remote + in-office).
• Willing to reside in or commute to Mahikeng, North West.

Responsabilidades

• Manage a caseload of complex insurance claims from initiation to settlement.
• Conduct investigations and gather evidence.
• Interpret policy terms, conditions, exclusions, and endorsements.
• Assess liability and coverage to determine settlement amounts.
• Negotiate settlements with claimants and third parties.
• Coordinate with internal and external stakeholders and ensure regulatory compliance.
• Maintain detailed records in the claims management system.

Conocimientos

Analytical skills

Negotiation

Investigations

Communication

Educación

NQF Level 4 in Short-Term Insurance

Herramientas

Claims management software

Descripción del empleo

About the Role

Our client, a reputable insurance provider, is seeking a diligent and experienced Insurance Claims Handler with a specialization in managing complex cases. This role is based in Mahikeng, North West , and requires a professional who can adeptly navigate intricate claims scenarios, ensuring fair and efficient resolution for policyholders. You will be responsible for investigating, assessing, and settling claims that fall outside the scope of standard procedures, requiring strong analytical skills and a deep understanding of policy wordings. This position is crucial for maintaining customer satisfaction and upholding the company's reputation for service excellence. The role operates on a hybrid model, balancing essential on-site work in Mahikeng with the flexibility of remote work.

Key Responsibilities

• Manage a caseload of complex and potentially contentious insurance claims from initiation to settlement.
• Conduct thorough investigations into the circumstances surrounding claims, gathering evidence and interviewing relevant parties.
• Interpret and apply complex policy terms, conditions, exclusions, and endorsements accurately.
• Assess liability, quantum, and coverage for claims, making well-reasoned decisions on settlement amounts.
• Negotiate settlements with claimants, legal representatives, and third parties in a professional and fair manner.
• Liaise with internal departments, such as legal and loss adjusting, as well as external service providers.
• Ensure compliance with all regulatory requirements, company policies, and service standards.
• Maintain accurate and detailed records of all claim activities, communications, and decisions within the claims management system.
• Identify opportunities for fraud detection and prevention, escalating suspicious claims accordingly.
• Provide clear and empathetic communication to policyholders throughout the claims process.

Requirements

• A minimum of 4 years of experience as an Insurance Claims Handler, with significant exposure to complex claims handling.
• Proven ability to analyze and interpret complex policy documents and legal frameworks.
• Strong negotiation, conflict resolution, and communication skills.
• Excellent investigative and problem-solving abilities.
• Proficiency in claims management software and standard office applications.
• Relevant insurance qualifications (e.g., NQF Level 4 in Short-Term Insurance) are highly desirable.
• Experience working within a hybrid environment, demonstrating effective remote and in-office collaboration.
• Attention to detail and a commitment to delivering high-quality service.
• Ability to work under pressure and manage a demanding workload efficiently.
• Must reside in or be willing to commute to Mahikeng, North West .

Benefits

• A competitive annual salary of up to ZAR, dependent on experience and claims handling expertise.
• Performance-based incentives.
• Medical aid and retirement fund contributions.
• Opportunities for professional development and specialized claims training.
• A supportive team environment within a well-respected insurance company.
• Hybrid working arrangements offering flexibility.
• Access to modern office facilities in Mahikeng, North West .