Senior Remote Claims Processor – Complex Claims Expert

Placements24; Bloemfontein; Hybrid; ZAR 450,000 - 600,000; Full time

Benefits offered by this job

Competitive salary

Fully remote

Medical aid

Retirement fund

Generous leave

Professional development

Remote team meetings

Job summary

Placements24 is seeking a Senior Claims Processor for a remote role with a leading South African insurance provider. You will handle end-to-end processing of complex claims, ensuring accuracy and policy compliance in a remote setting.

You will work from anywhere in South Africa, manage a portfolio of challenging claims, collaborate with stakeholders, and contribute to process improvements while staying current with regulatory requirements.

Qualifications

• Minimum 4 years in insurance claims processing with complex claims experience.
• Strong understanding of insurance principles, policies and procedures.
• Excellent analytical and problem-solving skills with high accuracy.
• Proficient in claims management software and standard office apps.
• Independent, organized, and able to work remotely.

Responsibilities

• Process complex claims from initiation to closure with accuracy and policy compliance.
• Investigate details, gather docs, and liaise with policyholders and intermediaries.
• Assess validity and determine actions based on coverage and guidelines.
• Manage a portfolio of complex claims, prioritizing tasks to meet deadlines.
• Communicate status updates clearly to all parties involved.
• Identify fraud indicators and escalate for investigation.
• Ensure data entry in the claims management system is accurate.
• Contribute to process improvements and efficiency initiatives.
• Provide guidance to junior handlers as needed.
• Stay informed on insurance products, regulations, and best practices.

Skills

Claims processing

Analytical thinking

Communication skills

Remote work ability

Time management

Education

High school diploma

Certifications in insurance

Tools

Claims management software

MS Office

Job description

Placements24 is seeking a Senior Claims Processor for a remote role with a leading South African insurance provider. You will handle end-to-end processing of complex claims, ensuring accuracy and policy compliance in a remote setting.

You will work from anywhere in South Africa, manage a portfolio of challenging claims, collaborate with stakeholders, and contribute to process improvements while staying current with regulatory requirements.