Senior Claims Assessor (Insurance)

Placements24; Midrand; Hybrid; ZAR 420,000 - 560,000; Full time

Benefits offered by this job

Hybrid work

Medical aid

Retirement fund

Professional development

Team-building

Wellness program

Annual leave

Bonuses

Job summary

Placements24 is seeking a Senior Claims Assessor in Midrand, Gauteng to manage complex insurance claims from initiation to settlement. You will determine coverage based on policy terms, gather evidence, and communicate decisions to stakeholders with clarity and integrity.

The role requires at least 5 years of claims experience, strong analytical and negotiation skills, and the ability to mentor juniors in a collaborative environment. A related Insurance/Law qualification is preferred.

Qualifications

• Minimum of 5 years of experience in insurance claims assessment, focusing on complex claims.
• Strong understanding of insurance principles, policy wordings and relevant legislation.
• Excellent analytical, problem-solving and decision-making skills.
• Strong negotiation and communication abilities, both written and verbal.
• Proficiency in using claims management software and MS Office Suite.
• Relevant tertiary qualification in Insurance, Law, or related field preferred.
• Ability to work independently and as part of a team.
• High level of integrity and ethical conduct.
• Experience mentoring junior staff is a plus.
• Commitment to continuous professional development in insurance.

Responsibilities

• Investigate, evaluate, and adjudicate complex insurance claims from initiation to settlement.
• Determine coverage based on policy terms, ensuring regulatory compliance.
• Communicate with claimants, policyholders, and legal representatives to gather information.
• Assess damages and liabilities using expert reports and evidence.
• Negotiate settlements within authority, aiming for fair outcomes.
• Prepare detailed reports documenting findings and actions.
• Mentor junior claims assessors and provide guidance.
• Identify potential fraud and escalate to relevant departments.
• Maintain accurate claim records in company systems.
• Contribute to process improvements in claims handling.

Skills

Analytical thinking

Negotiation

Communication

Problem solving

Team collaboration

Education

Insurance/Law degree

Tools

Claims management software

MS Office

Job description

About the Role Our client is a leading insurance provider seeking a highly experienced Senior Claims Assessor to join their dynamic team in Midrand, Gauteng. This pivotal role involves managing complex insurance claims, ensuring accuracy, fairness, and adherence to policy guidelines. The ideal candidate will possess a strong understanding of the insurance landscape and a proven track record in claims handling. This is an exciting opportunity to contribute to a reputable organization and play a crucial part in delivering exceptional service to policyholders. The role requires a professional who is detail-oriented and committed to upholding the highest standards of integrity in all claims-related activities. You will be part of a supportive environment that values professional growth and encourages continuous learning within the insurance sector. We are looking for individuals who are passionate about resolving claims efficiently and effectively, ensuring client satisfaction throughout the process.

Key Responsibilities

• Investigate, evaluate, and adjudicate complex insurance claims from initiation to settlement.
• Determine coverage based on policy terms and conditions, ensuring compliance with all relevant regulations.
• Communicate effectively with claimants, policyholders, legal representatives, and other stakeholders to gather information and explain claim decisions.
• Conduct thorough assessments of damages and liabilities, utilizing expert reports and evidence.
• Negotiate claim settlements within authority limits, striving for fair and equitable resolutions.
• Prepare detailed reports documenting claim findings, recommendations, and actions taken.
• Mentor and guide junior claims assessors, providing support and expertise.
• Identify potential fraudulent activities and elevate concerns to the appropriate departments.
• Maintain accurate and up-to-date claim records in the company's systems.
• Contribute to the continuous improvement of claims handling processes and procedures.

Requirements

• Minimum of 5 years of experience in insurance claims assessment, with a focus on complex claims.
• Proven understanding of insurance principles, policy wordings, and relevant legislation.
• Excellent analytical, problem-solving, and decision-making skills.
• Strong negotiation and communication abilities, both written and verbal.
• Proficiency in using claims management software and Microsoft Office Suite.
• Relevant tertiary qualification in Insurance, Law, or a related field is highly preferred.
• Ability to work independently and as part of a collaborative team.
• High level of integrity and ethical conduct.
• Experience in supervising or mentoring junior staff is a significant advantage.
• Commitment to continuous professional development within the insurance industry.

Benefits

• Competitive annual salary of R .
• Hybrid work model offering flexibility.
• Comprehensive medical aid and retirement fund contributions.
• Opportunities for professional development and career advancement.
• A supportive and collaborative work environment.
• Access to cutting-edge insurance technology and resources.
• Generous annual leave allowance.
• Performance-based bonuses and incentives.
• Regular team-building activities and social events.
• Employee wellness programs designed to support overall health and well-being.