Claims Manager/risk Manager

3 weeks ago


Johannesburg, South Africa Exclusively Remote Full time

Risk Manager specializing in the Healthcare Industry. This RM will be overseeing a team for claims management and claims consulting. Employee will have oversight of Risk Management policies and procedures and streamline the implementation and training of company employees. Employee should be knowledgeable in investigating and evaluating claims, determining the validity of claims, and negotiating settlements with claimants. This Employee will work closely with medical professionals, legal teams, and other stakeholders to ensure that claims are processed efficiently and effectively.

**Responsibilities;**

The job duties of a Senior Workers Compensation Claims Adjuster may include:

- Investigating and evaluating workers compensation claims
- Claims Management:

- On Site Safety Training
- Claims Investigation (includes emergency investigations)
- Compensability Determination
- Settlement Negotiation
- Litigation
- Reserve review
- Return to work program
- Subrogation
- Communicating with employers and insurance carriers to ensure that claims are processed in a timely and accurate manner
- Claims consulting teams:

- Claims oversight and management.
- Best practice and analysis.
- Book of business (carrier/client) reviews and trends.
- Loss control and recommendation process.
- Maintaining accurate records of claims and related documentation
- Staying up-to-date with changes in workers compensation laws and regulations
- Participating in training and professional development activities to enhance skills and knowledge

**Qualifications**

To be successful in this role, the Risk Manager should have strong analytical and problem-solving skills, excellent communication and negotiation skills, and the ability to work independently and as part of a team. They should also have a thorough understanding of workers compensation laws and regulations, as well as experience working with medical professionals and legal teams.

A bachelor's degree in a related field or relevant professional certifications (CSP, ARM, RRE) is required.

Working hours: 3pm - 11pm SA time


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