Senior Claims Assessor

Placements24; LegKraal Gate; Hybrid; ZAR 420,000 - 680,000; Full time

Benefits offered by this job

Hybrid work model

Bonus opportunities

Medical aid and retirement fund

Job summary

Placements24 seeks a Senior Claims Assessor for our client in Mahikeng, a leading insurance provider. You will oversee complex claims end-to-end, ensuring accuracy, fairness, and regulatory compliance while mentoring junior staff.

You will navigate policy reviews, liaise with stakeholders, and manage a demanding caseload. The role offers a hybrid work model and a clear path to advance in the North West region.

Qualifications

• 5-7 years of proven experience in claims assessing, preferably within the insurance industry.
• In-depth knowledge of various insurance policies, claims processes, and relevant legislation.
• Strong analytical, investigative, and problem-solving skills.
• Excellent negotiation, communication, and interpersonal skills.
• Leadership qualities and mentoring junior staff.

Responsibilities

• Investigate, evaluate, and settle complex insurance claims, including property, casualty, and liability claims.
• Conduct thorough reviews of policy documents to determine coverage and assess liability.
• Liaise with policyholders, third-party claimants, legal representatives, and other stakeholders to gather information and facilitate claim resolution.
• Manage a caseload of claims, prioritizing urgent matters and ensuring timely progress.
• Approve or deny claims based on policy terms, conditions, and investigation findings.
• Identify potential fraudulent claims and elevate to the appropriate internal departments.
• Provide clear and concise explanations of claim decisions to all parties involved.
• Mentor and guide junior claims assessors, offering expertise and support.
• Ensure all claims handling activities comply with industry regulations and company policies.
• Contribute to the continuous improvement of claims handling processes and procedures.

Skills

Analytical skills

Investigative skills

Problem-solving

Negotiation

Communication

Interpersonal skills

Leadership

Mentoring

Independent working

Education

Tertiary qualification in Insurance/Law/Commerce

Tools

Claims management software

MS Office

Job description

About the Role

Our client, a leading and reputable insurance provider, is seeking a highly skilled and experienced Senior Claims Assessor to join their dynamic team in Mahikeng . This pivotal role involves managing complex insurance claims from inception to resolution, ensuring accuracy, fairness, and compliance with all regulatory requirements. The successful candidate will play a crucial role in upholding the company's commitment to exceptional customer service and efficient claims processing. This is an exciting opportunity for a seasoned professional looking to advance their career in the insurance sector within the North West region of South Africa.

Key Responsibilities

• Investigate, evaluate, and settle complex insurance claims, including property, casualty, and liability claims.
• Conduct thorough reviews of policy documents to determine coverage and assess liability.
• Liaise with policyholders, third-party claimants, legal representatives, and other stakeholders to gather information and facilitate claim resolution.
• Manage a caseload of claims, prioritizing urgent matters and ensuring timely progress.
• Approve or deny claims based on policy terms, conditions, and investigation findings.
• Identify potential fraudulent claims and elevate to the appropriate internal departments.
• Provide clear and concise explanations of claim decisions to all parties involved.
• Mentor and guide junior claims assessors, offering expertise and support.
• Ensure all claims handling activities comply with industry regulations and company policies.
• Contribute to the continuous improvement of claims handling processes and procedures.

Requirements

• A relevant tertiary qualification in Insurance, Law, Commerce, or a related field is highly desirable.
• A minimum of 5-7 years of proven experience in claims assessing, preferably within the insurance industry.
• In-depth knowledge of various insurance policies, claims processes, and relevant legislation.
• Strong analytical, investigative, and problem-solving skills with meticulous attention to detail.
• Excellent negotiation, communication, and interpersonal skills, with the ability to manage difficult conversations.
• Proficiency in claims management software and standard office applications.
• Demonstrated leadership qualities and experience in mentoring junior staff.
• Ability to work independently and manage a demanding workload effectively.
• Commitment to ethical conduct and professional integrity.
• Reside in or be willing to relocate to the Mahikeng area.

Benefits

• Our client offers a competitive remuneration package commensurate with experience and qualifications, including a performance-based bonus structure.
• Employees will benefit from comprehensive medical aid and retirement fund contributions.
• Opportunities for professional development and continuous learning are provided, including support for further certifications.
• A dynamic and supportive work environment fosters collaboration and career growth.
• The role also offers the flexibility of a Hybrid work model, balancing office-based collaboration with remote work convenience.
• Join a company that values its employees and promotes a healthy work-life balance in Mahikeng .