Remote Senior Claims Processor - Complex Claims

Placements24; Bloemfontein; Híbrido; ZAR 450 000 - 600 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Competitive salary

Fully remote

Medical aid

Retirement fund

Generous leave

Professional development

Remote team meetings

Resumo da oferta

Placements24 is seeking a Senior Claims Processor for a remote role with a leading South African insurance provider. You will handle end-to-end processing of complex claims, ensuring accuracy and policy compliance in a remote setting.

You will work from anywhere in South Africa, manage a portfolio of challenging claims, collaborate with stakeholders, and contribute to process improvements while staying current with regulatory requirements.

Qualificações

• Minimum 4 years in insurance claims processing with complex claims experience.
• Strong understanding of insurance principles, policies and procedures.
• Excellent analytical and problem-solving skills with high accuracy.
• Proficient in claims management software and standard office apps.
• Independent, organized, and able to work remotely.

Responsabilidades

• Process complex claims from initiation to closure with accuracy and policy compliance.
• Investigate details, gather docs, and liaise with policyholders and intermediaries.
• Assess validity and determine actions based on coverage and guidelines.
• Manage a portfolio of complex claims, prioritizing tasks to meet deadlines.
• Communicate status updates clearly to all parties involved.
• Identify fraud indicators and escalate for investigation.
• Ensure data entry in the claims management system is accurate.
• Contribute to process improvements and efficiency initiatives.
• Provide guidance to junior handlers as needed.
• Stay informed on insurance products, regulations, and best practices.

Conhecimentos

Claims processing

Analytical thinking

Communication skills

Remote work ability

Time management

Formação académica

High school diploma

Certifications in insurance

Ferramentas

Claims management software

MS Office

Descrição da oferta de emprego

About the Role

Our client, a reputable insurance provider, is seeking a dedicated Senior Claims Processor specializing in complex claims to join their fully remote team. This role offers the flexibility to work from anywhere in South Africa, providing a significant opportunity to manage challenging claims efficiently and effectively without the need for physical office presence. You will be responsible for the end-to-end processing of intricate insurance claims, ensuring accuracy, adherence to policy terms, and timely resolution. The ideal candidate will possess a deep understanding of various insurance products, exceptional attention to detail, and a proven ability to handle complex scenarios with professionalism and efficiency. This is a remote-first position, emphasizing autonomy and strong organizational skills. You will play a vital role in maintaining customer satisfaction by providing prompt and accurate claim settlements. Your ability to navigate intricate policy details and regulatory requirements will be essential for success in this independent role. We are looking for self-starters who thrive in a home-based work environment and are committed to delivering high-quality service.

Key Responsibilities

• Process complex insurance claims from initiation to closure, ensuring accuracy and compliance with policy terms and conditions.
• Investigate claim details, gather necessary documentation, and liaise with policyholders, intermediaries, and other relevant parties.
• Assess claim validity and determine the appropriate course of action based on policy coverage and guidelines.
• Manage a portfolio of complex claims, prioritizing tasks and meeting strict deadlines.
• Communicate claim status updates clearly and professionally to all involved parties.
• Identify potential fraud indicators and escalated suspicious claims for further investigation.
• Ensure all claim-related data is accurately entered and maintained in the claims management system.
• Contribute to the continuous improvement of claims processing procedures and efficiency.
• Provide guidance and support to junior claims handlers as needed.
• Stay informed about changes in insurance products, regulations, and best practices.

Requirements

• A minimum of 4 years of experience in insurance claims processing, with demonstrated experience handling complex claims.
• Strong understanding of insurance principles, policies, and claims procedures across various lines of business.
• Excellent analytical and problem-solving skills with a high degree of accuracy and attention to detail.
• Proficiency in using claims management software and standard office applications.
• Exceptional communication and interpersonal skills, both written and verbal.
• Proven ability to manage time effectively, prioritize tasks, and work independently in a remote setting.
• Must have a reliable internet connection and a suitable home office environment.
• High school diploma or equivalent; further education or relevant certifications are a plus.
• Ability to adapt to changing processes and technological advancements.
• A proactive and customer-centric approach to claim handling.

Benefits

• Competitive salary commensurate with experience.
• Fully remote work arrangement with flexibility.
• Comprehensive medical aid and retirement fund contributions.
• Generous annual leave and paid public holidays.
• Opportunities for professional development and specialized training.
• A supportive remote team environment and regular virtual team meetings.
• The chance to work with a reputable and established insurance company.
• Regular performance reviews and feedback.
• Contribution towards home office setup or internet costs.