Large Loss and Complex Claims Specialist

SUMMARY:

POSITION INFO:
Minimum Requirements Matric. RE5 qualification. Degree in Law, Risk Management, Insurance, Commerce, or a related field. Class of Business certification (advantageous). FAIS Fit and Proper compliant. 5-10 years' experience in short-term insurance claims. Proven experience handling large losses and complex commercial claims. Experience managing claims valued at R1 million+ . Strong technical exposure to: Commercial Property Claims Engineering Claims Liability Claims Business Interruption Claims Motor & Fleet Claims Experience drafting technical coverage opinions, claim determinations, and repudiation letters. Sound understanding of insurance law, policy interpretation, and claims governance Key Responsibilities Manage large loss and complex claims from notification through to final settlement or closure. Assess policy coverage, exclusions, endorsements, warranties, conditions, and limits. Evaluate liability, indemnity, and quantum to determine appropriate claim outcomes. Review and validate repair quotations, replacement costs, business interruption calculations, and expert reports. Liaise with attorneys, loss adjusters, engineers, assessors, forensic investigators, brokers, and insured clients. Draft technical coverage opinions, repudiation letters, and settlement recommendations. Prepare business cases and ex gratia settlement motivations for senior management approval. Identify fraud indicators and escalate suspicious claims activity where necessary. Compile claims summaries, exposure analyses, and reserve recommendations. Provide technical guidance and support to internal stakeholders. Competencies Advanced policy interpretation and coverage assessment skills. Strong analytical and investigative abilities. Excellent negotiation and conflict resolution skills. Strong decision-making and problem-solving capability. Exceptional stakeholder management skills. Ability to work independently and manage competing priorities. High levels of professionalism, integrity, and accountability. Apply If you have a passion for technically challenging claims and possess the expertise to manage high-value, complex matters, we would like to hear from you.