Senior Insurance Claims Assessor

Placements24; KwaZulu-Natal; Hybrid; ZAR 450,000 - 600,000; Full time

Benefits offered by this job

Medical aid

Retirement fund

Generous leave

Development opportunities

Hybrid work model

Wellness programs

Job summary

Placements24 is seeking a Senior Insurance Claims Assessor to join our client in Pietermaritzburg. The role combines office-based duties with remote flexibility in a hybrid work model.

You will assess complex insurance claims, interpret policy wordings, and ensure accurate, compliant decisions for a range of policy types. Ideal candidates have at least 5 years of claims experience, excellent analytical and communication skills, and a solid understanding of South African insurance regulations.

Qualifications

• A tertiary qualification in Law, Business Administration, Risk Management or related field is highly preferred.
• Minimum 5 years proven experience in insurance claims assessment with knowledge of various products.
• Excellent analytical, problem-solving and decision-making skills.
• Exceptional written and verbal communication and interpersonal abilities.

Responsibilities

• Thoroughly investigate, evaluate and adjudicate complex insurance claims across policy types (property, casualty, motor, health).
• Interpret policy wordings, conditions and exclusions to determine coverage and liability.
• Assess damages, losses and expenses incurred by claimants.
• Communicate with policyholders, brokers, legal representatives and other stakeholders to gather information and explain decisions.
• Collaborate with underwriting and legal to resolve complex claims issues.
• Ensure compliance with legislation, regulations and company policies.
• Identify potential fraudulent claims and escalate for investigation when needed.
• Maintain detailed records of all claim activities and decisions.
• Mentor junior claims assessors and contribute to process improvements.

Skills

Insurance claims

Investigations

Analytical thinking

Communication

Education

Law degree

Business Administration degree

Risk Management degree

Tools

Claims software

MS Office

Job description

About the Role

Our client, a prominent leader in the insurance sector, is seeking a highly skilled and experienced Senior Insurance Claims Assessor to join their dynamic team in Pietermaritzburg, KwaZulu-Natal. This role is crucial for maintaining the integrity and efficiency of our claims processing department. You will be responsible for evaluating complex insurance claims, ensuring accurate assessments, and providing exceptional service to our policyholders. This is an exciting opportunity to contribute to a reputable organization and advance your career in a challenging yet rewarding environment. The successful candidate will work in a hybrid capacity, balancing office-based responsibilities with remote flexibility, fostering a modern and efficient work culture within the Pietermaritzburg region.

Key Responsibilities

• Thoroughly investigate, evaluate, and adjudicate complex insurance claims across various policy types (e.g., property, casualty, motor, health).
• Interpret policy wordings, conditions, and exclusions to determine coverage and liability.
• Conduct detailed assessments of damages, losses, and expenses incurred by claimants.
• Communicate effectively with policyholders, brokers, legal representatives, and other stakeholders to gather information and explain claim decisions.
• Collaborate with internal departments, including underwriting and legal, to resolve complex claims issues.
• Ensure compliance with all relevant legislation, regulatory requirements, and company policies.
• Identify potential fraudulent claims and escalate for further investigation as needed.
• Maintain accurate and detailed records of all claim activities and decisions within the company's claims management system.
• Mentor and provide guidance to junior claims assessors.
• Contribute to the continuous improvement of claims handling procedures and best practices.

Requirements

• A relevant tertiary qualification in Law, Business Administration, Risk Management, or a related field is highly preferred.
• A minimum of 5 years of proven experience in insurance claims assessment, with a strong understanding of various insurance products.
• Excellent analytical, problem-solving, and decision-making skills.
• Exceptional communication (written and verbal) and interpersonal skills.
• Proficiency in using claims management software and standard office applications.
• Ability to work independently and as part of a team, demonstrating strong time management and organizational skills.
• A deep understanding of the insurance industry and relevant South African legal frameworks.
• Attention to detail and a commitment to accuracy.
• Resilience and the ability to handle high-pressure situations.
• Experience in the KwaZulu-Natal market is advantageous.

Benefits

• Competitive annual salary package commensurate with experience.
• Comprehensive medical aid and retirement fund contributions.
• Generous annual leave allowance.
• Opportunities for professional development and further training.
• Access to cutting-edge claims management technology.
• A supportive and collaborative work environment within a leading financial services group.
• Hybrid work model offering a balance between office and remote work.
• Employee wellness programs and benefits.