Senior Claims Administrator - Policy Processing & Compliance

Placements24; Klerksdorp; Hybrid; ZAR 420,000 - 640,000; Full time

Benefits offered by this job

Competitive salary

Performance-based bonuses

Remote work support including techstip

Professional development and training

Flexible autonomous work environment

Job summary

Placements24 is seeking a Senior Claims Administrator for a remote-based role supporting clients across South Africa, including the North West province. You will oversee the entire lifecycle of insurance claims, ensuring accuracy and regulatory compliance, while liaising with policyholders and third parties to gather information and provide updates.

The role requires at least 4 years in claims administration, strong organizational skills for remote work, and proficiency with claims software and

Qualifications

• 4+ years of experience in insurance claims administration.
• Solid understanding of policy wordings and claims procedures.
• Ability to handle high claim volumes with accuracy.
• Strong remote-work organization and time management.
• Excellent communication with stakeholders.
• Knowledge of SA insurance regulations and compliance.

Responsibilities

• Oversee end-to-end processing of insurance claims.
• Verify policy coverage and assess claim validity.
• Maintain claim files in the claims management system.
• Liaise with policyholders, brokers, and third parties.
• Ensure regulatory compliance and policy adherence.
• Process payments, settlements, reimbursements.
• Generate reports on status, processing times and compliance.
• Provide guidance to junior team members.
• Identify opportunities to improve processing efficiency.

Skills

Insurance claims experience

Attention to detail

Remote work

Communication skills

Tools

Claims management software

MS Office Suite

Job description

About the Role

Our client, a well-established insurance provider, is seeking a diligent and experienced Senior Claims Administrator to join their remote-based operations. This role is crucial for ensuring the efficient and accurate processing of insurance claims and maintaining high standards of regulatory compliance. The ideal candidate will have a strong background in claims administration, a meticulous eye for detail, and a deep understanding of insurance policies and procedures. You will be responsible for overseeing the entire lifecycle of a claim, from initial registration to final settlement, ensuring all documentation is accurate and compliant with industry standards. This is a fantastic opportunity for a seasoned professional to contribute to a growing organization from the comfort of their own home, supporting clients across the North West province and beyond. The role requires exceptional organizational skills and the ability to manage multiple tasks effectively in a remote setting. You will work autonomously, leveraging technology to maintain seamless communication and workflow with the wider team and external stakeholders. Your dedication to accuracy and compliance will be paramount in upholding our client's reputation for excellent service and integrity in claim management.

Key Responsibilities

• Oversee the end-to-end processing of insurance claims, ensuring accuracy and adherence to policy terms.
• Verify policy coverage and assess claim validity based on submitted documentation and investigation findings.
• Maintain accurate and comprehensive claim files in the company's claims management system.
• Liaise with policyholders, brokers, and third parties to gather necessary information and provide updates.
• Ensure compliance with all relevant insurance regulations, company policies, and procedures.
• Process claim payments, settlements, and reimbursements accurately and efficiently.
• Identify potential fraud indicators and elevate suspicious claims for further investigation.
• Generate reports on claim status, processing times, and compliance metrics.
• Provide guidance and support to junior claims administrators and team members.
• Continuously seek opportunities to improve claims processing efficiency and customer service.

Requirements

• A minimum of 4 years of experience in insurance claims administration or processing.
• In-depth understanding of various insurance products, policy wordings, and claims procedures.
• Proven ability to manage a high volume of claims with exceptional accuracy and attention to detail.
• Strong organizational and time management skills, essential for remote work.
• Excellent communication and interpersonal skills for effective stakeholder liaison.
• Proficiency in claims management software and MS Office Suite (Word, Excel, Outlook).
• Familiarity with South African insurance regulations and compliance requirements.
• Ability to work independently, demonstrate initiative, and problem-solve effectively.
• A commitment to maintaining confidentiality and upholding ethical standards.
• Home office setup with reliable internet connectivity is required.

Benefits

• Competitive annual salary, reflecting your experience and skills.
• Performance-based bonuses recognizing your contributions to efficiency and accuracy.
• Comprehensive remote work support, including potential technology stipends.
• Opportunities for professional development and training in advanced claims management.
• A flexible and autonomous work environment allowing for excellent work-life balance.
• Be part of a reputable insurance company with a strong focus on service excellence.
• Contribute to a dynamic team environment while working from your chosen location in Klerksdorp .