Senior Claims Resolution Specialist (Remote)

Placements24; Randburg; Hybrid; ZAR 900,000 - 1,300,000; Full time

Benefits offered by this job

Competitive salary package

Fully remote position

Professional development

Excellent team culture

Job summary

Placements24 is seeking a Senior Claims Resolution Specialist for a fully remote position in South Africa. The role focuses on resolving complex, high-value insurance claims with emphasis on policy interpretation, evidence gathering, and timely settlements.

You will work within a remote-first, flexible environment, collaborating with underwriters, legal counsel, and other departments. A strong track record in claims management and excellent communication is essential.

Qualifications

• 6+ years in insurance claims handling, with focus on complex or high-value claims.
• Expert knowledge of insurance policies, claim investigation techniques, and negotiation strategies.
• Strong analytical, critical thinking, and problem-solving skills.

Responsibilities

• Manage a portfolio of complex/high-value claims from initiation to closure.
• Conduct investigations, gather evidence, and analyze policy terms for coverage.
• Negotiate settlements with claimants, their legal representatives, and third parties.
• Ensure accurate claim documentation and maintain records in the system.
• Adhere to regulatory requirements and company policies.
• Identify fraud, subrogation, or litigation opportunities and escalate when needed.
• Provide clear and empathetic communication to involved parties.
• Collaborate with underwriters, legal counsel, and other teams to resolve claims.
• Mentor junior claims handlers on complex cases.
• Continuously seek improvements to the resolution process and customer experience.

Skills

Claims handling

Negotiation

Analytical thinking

Communication

Education

Insurance or law degree

Tools

Claims management software

Job description

About the Role

Our client, a distinguished insurer renowned for its customer-centric approach, is seeking a highly experienced Senior Claims Resolution Specialist to join their expanding fully remote team. This pivotal role focuses on expertly managing and resolving complex, sensitive, and high-value insurance claims. You will leverage your deep understanding of claims procedures, policy interpretation, and negotiation skills to achieve fair and timely settlements, ensuring exceptional customer satisfaction. Operating in a remote-first capacity, this position provides significant flexibility and the opportunity to work from anywhere within South Africa. We are dedicated to cultivating a collaborative virtual environment where your expertise is valued, and your contributions directly impact our client's reputation for reliability and service excellence. The ideal candidate will possess strong analytical acumen, exceptional communication skills, and a proven ability to navigate challenging claims scenarios with professionalism and efficiency. This is an exceptional opportunity to advance your career in claims management within a supportive and forward-thinking organization.

Key Responsibilities

• Manage and resolve a portfolio of complex and high-value insurance claims from initiation to closure.
• Conduct thorough investigations, gather evidence, and analyze policy terms to determine coverage.
• Negotiate settlements with claimants, legal representatives, and third parties.
• Ensure accurate claim documentation and maintain detailed records in the claims management system.
• Adhere strictly to regulatory requirements, company policies, and industry best practices.
• Identify and escalat potential fraud, subrogation, or litigation opportunities.
• Provide clear, empathetic, and timely communication to all involved parties.
• Collaborate with underwriters, legal counsel, and other departments to facilitate claim resolution.
• Mentor and provide guidance to junior claims handlers on complex cases.
• Continuously seek ways to improve the claims resolution process and customer experience.

Requirements

• A minimum of 6 years of experience in insurance claims handling, with a significant focus on complex or high-value claims.
• Expert knowledge of insurance policies, claim investigation techniques, and negotiation strategies.
• Strong analytical, critical thinking, and problem-solving skills.
• Exceptional verbal and written communication, negotiation, and interpersonal skills.
• Proficiency in claims management software and standard office applications.
• Ability to work independently, manage workload effectively, and meet stringent deadlines in a remote setting.
• A relevant tertiary qualification in insurance, law, or a related discipline is highly advantageous.
• Commitment to ethical conduct and customer service excellence.
• Must possess a reliable internet connection and a conducive home office environment.
• Demonstrated ability to handle sensitive situations with diplomacy and professionalism.

Benefits

• Competitive salary package and performance-based bonuses.
• Fully remote position offering unparalleled work-life balance and flexibility.
• Opportunities for professional development and advanced training.
• Exposure to diverse and challenging claims cases.
• Supportive and collaborative virtual team culture.
• Contribution to a leading insurance provider known for its excellent service.
• Comprehensive medical and retirement benefits.