Senior Claims Assessor

Placements24; Rustenburg; Hybrid; ZAR 420,000 - 650,000; Full time

Benefits offered by this job

Competitive salary

Remote work flexibility

Medical and retirement benefits

Professional development

Job summary

Placements24 is recruiting a Senior Claims Assessor for a fully remote role within South Africa. The position suits a seasoned professional who can manage complex claims independently while delivering excellent customer service.

You will investigate, evaluate, and settle claims, determine coverage, negotiate settlements, and maintain detailed files. The role emphasizes autonomy, integrity, and collaboration with legal counsel and external adjusters.

Qualifications

• 5+ years of experience in claims assessment in insurance.
• Proven track record handling complex claims.
• Strong knowledge of policies, laws, and investigation techniques.
• Autonomous, remote-friendly with strong communication.
• Proficiency with claims software and MS Office.

Responsibilities

• Investigate, evaluate and settle complex claims efficiently.
• Gather evidence, interview claimants and witnesses.
• Determine coverage eligibility and liability.
• Negotiate settlements while protecting company interests.
• Maintain detailed claim files and documentation.
• Identify potential fraud indicators.
• Support junior claims handlers with guidance.
• Ensure compliance with insurance laws and policies.

Skills

Claims assessment

Negotiation

Investigation

Remote work

Attention to detail

Policy knowledge

Tools

Claims software

Job description

About the Role Our client, a distinguished name in the insurance industry, is actively recruiting a Senior Claims Assessor for a completely remote position. This role is designed for a seasoned professional who can manage complex insurance claims independently from their chosen location within South Africa. You will be instrumental in ensuring fair and efficient claims processing, providing exceptional service to policyholders while mitigating financial risks for the company. As a remote-first organization, we provide the necessary technological tools and support to enable seamless operation and collaboration. This is an exciting opportunity for an experienced claims professional seeking autonomy and career progression in a fully remote setup.

Key Responsibilities

• Investigate, evaluate, and settle complex insurance claims efficiently and accurately, adhering to policy terms and conditions.
• Conduct thorough investigations, including gathering evidence, interviewing claimants and witnesses, and liaising with external adjusters and legal counsel when necessary.
• Determine coverage eligibility and liability, making sound judgments on claim validity and settlement amounts.
• Negotiate settlements with claimants and third parties, aiming for fair resolutions while protecting the company's interests.
• Maintain accurate and detailed claim files, documenting all activities, communications, and decisions.
• Identify potential fraud indicators and elevate suspicious claims for further investigation.
• Provide guidance and support to junior claims handlers, sharing expertise and best practices.
• Ensure compliance with all relevant insurance laws, regulations, and company policies.

Requirements

• A minimum of 5 years of experience in claims assessment, preferably within short-term or long-term insurance.
• Proven track record of successfully managing a diverse caseload of complex claims.
• Strong understanding of insurance policies, legal principles, and claims investigation techniques.
• Excellent negotiation, communication, and interpersonal skills.
• High level of integrity, attention to detail, and ability to make objective decisions.
• Proficiency in claims management software and standard office applications.
• Demonstrated ability to work autonomously and manage workload effectively in a remote environment.
• Resilient and adaptable, with a strong commitment to delivering excellent customer service.

Benefits

• Competitive salary and performance-based incentives.
• Comprehensive medical and retirement benefits.
• Generous leave policy and flexibility in working hours.
• Opportunities for professional development, certifications, and advanced training.
• A supportive remote work culture with regular virtual team interactions.
• The ability to work from home with full technological support.
• Career growth prospects within a reputable insurance organization.