Senior Claims Assessor - Remote

Placements24; Midrand; Hybrid; ZAR 420,000 - 700,000; Full time

Benefits offered by this job

Comprehensive remote setup support

Professional development & training

Access to advanced claims management‑/

Performance incentives & bonuses

Generous leave policy

Provident fund & medical aid

Job summary

Placements24 is seeking a Senior Claims Assessor for a fully remote role in South Africa. You will assess complex insurance claims, guide policy interpretation, and ensure compliance with SA regulations.

You will work independently, manage a caseload, and coordinate with stakeholders from anywhere in SA. The ideal candidate has 5+ years in claims assessment, strong analytical and negotiation skills, and a track record of accuracy and integrity.

Qualifications

• At least 5 years of proven experience in insurance claims assessment, focusing on complex claims.
• Strong knowledge of South African insurance legislation and regulatory frameworks.
• Excellent analytical, problem-solving, and decision-making skills.
• Excellent communication, negotiation, and interpersonal skills.
• Ability to work independently in a remote environment.
• Relevant tertiary qualification in Insurance, Law, Finance, or related field is highly desirable.
• Experience in short-term, long-term, or specialized policies is advantageous.
• Reliable internet connection and a dedicated home office setup.

Responsibilities

• Investigate, evaluate, and adjudicate complex insurance claims accurately and efficiently.
• Gather and analyze documentation to determine claim validity and payout amounts.
• Communicate professionally with policyholders, claimants, and other parties throughout the claims process.
• Maintain detailed records in the claims management system.
• Identify fraud indicators and escalate suspicious cases.
• Provide guidance to junior claims handlers.
• Stay updated on industry trends and regulatory changes.
• Contribute to development of claims handling procedures.
• Manage a caseload from inception to closure and ensure timely resolution.
• Participate in remote team meetings and contribute to departmental objectives.

Job description

About the Role

Our client, a leading provider in the insurance sector, is seeking a highly experienced and dedicated Senior Claims Assessor to join their dynamic team. This is a fully remote position, offering the flexibility to work from anywhere within South Africa. The ideal candidate will possess a deep understanding of insurance policies, claims processing, and regulatory compliance. You will play a crucial role in ensuring the efficient and accurate assessment of complex insurance claims, contributing significantly to customer satisfaction and the company's reputation for excellence. This role demands a proactive approach, exceptional analytical skills, and a commitment to upholding the highest standards of integrity. The Senior Claims Assessor will work independently, leveraging technology to manage a caseload and collaborate with internal and external stakeholders. This position is integral to the claims department's success and offers significant growth opportunities within a forward-thinking organization committed to its employees' professional development. The fully remote nature of this role allows for a better work-life balance, focusing on results and performance.

Key Responsibilities

• Investigate, evaluate, and adjudicate complex insurance claims accurately and efficiently, ensuring compliance with policy terms and conditions.
• Gather and analyze all relevant documentation, including incident reports, medical records, and repair estimates, to determine claim validity and payout amounts.
• Communicate effectively and professionally with policyholders, claimants, legal representatives, and other relevant parties throughout the claims process.
• Maintain detailed and accurate records of all claims assessments, decisions, and communications within the company's claims management system.
• Identify potential fraud indicators and elevate suspicious cases to the appropriate departments for further investigation.
• Provide expert advice and guidance to junior claims handlers and other team members.
• Stay updated on industry trends, regulatory changes, and best practices in claims assessment.
• Contribute to the development and improvement of claims handling procedures and guidelines.
• Manage a designated caseload of claims from inception to closure, ensuring timely resolution.
• Participate in remote team meetings and contribute to departmental objectives.

Requirements

• A minimum of 5 years of proven experience in insurance claims assessment, with a focus on complex claims.
• Strong understanding of South African insurance legislation and regulatory frameworks.
• Excellent analytical, problem-solving, and decision-making skills.
• Exceptional communication, negotiation, and interpersonal skills.
• Proficiency in using claims management software and standard office productivity tools.
• Ability to work independently and manage time effectively in a remote work environment.
• A relevant tertiary qualification in Insurance, Law, Finance, or a related field is highly desirable.
• Demonstrated ability to handle sensitive information with discretion and maintain confidentiality.
• Experience in specific insurance lines such as short-term, long-term, or specialized policies is an advantage.
• Must possess a reliable internet connection and a dedicated home office setup conducive to remote work.

Benefits

• Competitive annual salary of ZAR.
• Comprehensive remote work setup support.
• Opportunities for professional development and continuous learning.
• Access to cutting-edge claims management technology.
• A supportive and collaborative virtual team environment.
• Generous leave allocation and company-mandated holidays.
• Contribution to a provident fund and medical aid scheme.
• Performance-based bonuses and incentives.
• Work-life balance supported by a fully remote model.