Senior Claims Assessor - WhatJobs Direct

Placements24; Midrand; Hybrid; ZAR 510,000 - 870,000; Full time

Benefits offered by this job

Medical aid

Retirement fund

Bonuses

Job summary

Placements24 is seeking a Senior Claims Assessor in Midrand, Gauteng, to expertly assess and adjudicate complex insurance claims, ensuring compliance with SA regulations. The role requires mentoring junior staff and coordinating with policyholders and legal representatives.

The ideal candidate has 5+ years in claims assessment across short-term, life, and health policies, with strong analytical and negotiation skills. A hybrid work model is offered in a dynamic financial services environment.

Qualifications

• Minimum 5 years insurance claims assessment experience.
• Experience with short-term, life, and health claims.
• Strong knowledge of SA insurance law and regulatory frameworks.

Responsibilities

• Accurately assess and adjudicate complex insurance claims.
• Investigate claim details and gather documentation.
• Mentor junior claims assessors.
• Ensure compliance with industry regulations.
• Identify potential fraudulent claims and escalate.
• Communicate decisions to stakeholders.

Skills

Insurance claims assessment

Regulatory compliance

Leadership mentoring

Analytical thinking

Education

Tertiary qualification in Law

BA/BS in related field

Tools

Claims management software

MS Office

Job description

About the Role

Our client, a leading financial services provider, is seeking a highly experienced and diligent Senior Claims Assessor to join their dynamic team in Midrand, Gauteng . This role is pivotal in ensuring the efficient and accurate processing of insurance claims, upholding the company's reputation for integrity and customer service. The ideal candidate will possess a deep understanding of insurance policies, claim adjudication, and regulatory compliance. This is a fantastic opportunity to advance your career within a reputable organisation that values expertise and offers significant professional development.

Key Responsibilities

• Accurately assess and adjudicate complex insurance claims in accordance with policy terms and conditions.
• Investigate claim details, gather necessary documentation, and liaise with policyholders, legal representatives, and other relevant parties.
• Determine claim validity, liability, and the appropriate settlement amount.
• Maintain detailed and accurate records of all claim activities and decisions.
• Provide expert guidance and mentorship to junior claims assessors.
• Ensure compliance with all relevant industry regulations and internal company policies.
• Identify potential fraudulent claims and elevate them for further investigation.
• Contribute to the continuous improvement of claims handling processes and procedures.
• Communicate claim decisions and explanations clearly and professionally to stakeholders.
• Participate in regular team meetings and contribute to strategic planning discussions related to claims management.

Requirements

• A relevant tertiary qualification in Law, Business Administration, or a related field.
• A minimum of 5 years of experience in insurance claims assessment, preferably within the Midrand, Gauteng area.
• Proven expertise in assessing a wide range of insurance claims (e.g., short-term, life, health).
• Strong understanding of South African insurance law and regulatory frameworks.
• Excellent analytical, problem-solving, and decision-making skills.
• Exceptional communication and interpersonal skills, with the ability to negotiate effectively.
• Proficiency in claims management software and standard office applications.
• Ability to work independently and as part of a team, managing a demanding workload.
• Demonstrated leadership potential or experience in mentoring junior staff.
• A proactive approach to identifying and mitigating risks.

Benefits

This role offers a competitive annual salary of , commensurate with experience. Additionally, our client provides a comprehensive benefits package including medical aid, a retirement fund, and performance-based bonuses. Employees also have access to ongoing professional development opportunities and a supportive work environment in the heart of Midrand, Gauteng . The hybrid work arrangement allows for a healthy work-life balance, combining the benefits of office collaboration with the flexibility of remote work. Join a company that invests in its people and offers a clear path for career progression in the insurance sector.