Remote Claims Assessor Specialist

Placements24; Cape Town; Hybrid; ZAR 420,000 - 540,000; Full time

Benefits offered by this job

Medical aid

Provident fund

Paid time off

Professional development

Remote work

Job summary

Placements24 seeks a dedicated Claims Assessor Specialist for a fully remote role. You will manage claims from initiation to settlement, review coverage and documentation, and communicate clearly with policyholders.

You will collaborate with adjusters, legal counsel, and internal teams to resolve complex claims while ensuring compliance with regulations and company standards. A strong emphasis on customer service and accuracy is required.

Qualifications

• Bachelor's degree in Business Administration, Law, or related field preferred.
• Minimum 3 years hands-on claims assessment experience in insurance.
• Understanding of insurance policies, claim investigation, and settlement procedures.
• Excellent communication, negotiation, and problem-solving with empathy and customer care.

Responsibilities

• Investigate, evaluate, and process a high volume of insurance claims from initiation to settlement.
• Review policy coverage, claim details, and documentation to determine validity and payout amounts.
• Explain procedures, coverage, and settlements with policyholders clearly and empathetically.
• Collaborate with external adjusters, legal counsel, and third parties to resolve complex claims.
• Ensure compliance with legal requirements, regulatory mandates, and company practices.
• Maintain accurate claim files in the claims management system.
• Identify potentially fraudulent claims and escalate as needed.
• Provide exceptional customer service to ensure timely and fair resolutions.
• Assist in process improvements to enhance efficiency and customer experience.

Skills

Claims assessment

Communication

Negotiation

Problem solving

Empathy

Customer care

Education

Bachelor's degree (Business Administration / Law / related)

Tools

Claims management system

Job description

About the Role

Our client, a leading national insurance provider, is actively seeking a dedicated and detail-oriented Claims Assessor Specialist to join their fully remote team. This pivotal role is responsible for managing and settling insurance claims efficiently and accurately, ensuring customer satisfaction and adherence to company policies and regulatory standards. As a remote-first position, you will have the autonomy to manage your workload from your home office, leveraging advanced digital tools and communication platforms to connect with policyholders, investigators, and internal stakeholders. This is an excellent opportunity for an experienced professional looking to excel in a flexible, remote work environment while contributing to the core operations of a reputable insurance firm.

Key Responsibilities

• Investigate, evaluate, and process a high volume of insurance claims from initiation to settlement.
• Conduct thorough reviews of policy coverage, claim details, and supporting documentation to determine validity and payout amounts.
• Communicate effectively and empathetically with policyholders to explain claim procedures, coverage, and settlement offers.
• Collaborate with external adjusters, legal counsel, and other third parties to gather necessary information and resolve complex claims.
• Ensure all claims handling activities comply with legal requirements, regulatory mandates, and company best practices.
• Maintain accurate and up-to-date claim files using the company's claims management system.
• Identify potential fraudulent claims and upscale them to the appropriate investigation teams.
• Provide exceptional customer service throughout the claims process, aiming for timely and fair resolutions.
• Contribute to process improvement initiatives aimed at enhancing claims handling efficiency and customer experience.

Requirements

• A Bachelor's degree in Business Administration, Law, or a related field is preferred.
• A minimum of 3 years of hands-on experience in claims assessment, preferably within the insurance industry.
• Demonstrated understanding of insurance policies, claim investigation techniques, and settlement procedures.
• Exceptional communication, negotiation, and problem-solving skills, with a strong emphasis on empathy and customer care.
• Proficiency in using digital claims management systems and standard office software (e.g., Microsoft Office Suite).
• Must have a reliable internet connection and a dedicated home office setup suitable for remote work.
• Ability to work independently, manage time effectively, and meet performance targets in a remote setting.
• Relevant professional certifications in insurance claims handling are a plus.

Benefits

• This remote position offers a competitive annual salary, along with performance incentives.
• The company provides a comprehensive benefits package, including medical aid, a provident fund, and paid time off.
• You will receive continuous professional development opportunities and access to cutting-edge digital tools.
• The flexibility of working from home allows for a superior work-life balance, eliminating commute times and offering greater control over your workday.
• Join a supportive, digitally-enabled team and advance your career in a forward-thinking insurance environment.