Insurance Claims Examiner

1 week ago

Amrāvati, Maharashtra, India beBeeClaims Full time ₹ 9,00,000 - ₹ 12,34,567
Insurance Claim Specialist Position Overview

We are seeking a skilled Insurance Claim Specialist to oversee the entire claims settlement process from submission to final resolution.

The ideal candidate will have strong analytical and communication skills, with the ability to assess claims, investigate their validity, and ensure timely and fair settlements.

  • ">Key Responsibilities:
  • ">Claims Processing:
  • ">Handle all aspects of claims processing, including reviewing submitted documentation and determining eligibility based on policy coverage.
  • ">Data Analysis:
  • ">Analyse data according to established Standard Operating Procedures (SOPs) to guarantee accurate and efficient claim handling.
  • ">Claim Validation & Investigation:
  • ">Conduct thorough investigations by collecting relevant data, conducting interviews, and collaborating with adjusters and external experts to verify claim validity.
  • ">Client Communication:
  • ">Maintain open lines of communication with policyholders and agents regarding claim status, provide clarity on coverage decisions, and guide them through the settlement process.
  • ">Settlement Negotiation:
  • ">Negotiate settlement amounts with claimants and third parties, ensuring that settlements are fair, within policy limits, and compliant with legal standards.
  • ">Documentation & Reporting:
  • ">Maintain detailed records of claims processing activities, including assessments, investigation reports, and settlement documentation.
  • ">Fraud Detection:
  • ">Identify potential fraudulent claims and collaborate with the fraud investigation team when necessary.
  • ">Compliance:
  • ">Ensure all claims are processed in accordance with company policies, industry regulations, and legal requirements.
  • ">Coordination with Legal Team:
  • ">Collaborate with the legal team on disputed claims or cases involving litigation to guarantee proper handling.
  • ">Customer Service:
  • ">Deliver exceptional customer service by addressing claim-related inquiries, resolving disputes, and ensuring a seamless claims experience for policyholders.
  • ">Continuous Improvement:
  • ">Recommend improvements to enhance efficiency and reduce claims processing time.

Requirements:

  • A solid understanding of insurance policies, claims processes, and regulatory requirements is essential.
  • Proven negotiation and conflict resolution skills are required.
  • The ability to analyze complex claims data for fair settlement decisions is crucial.
  • Strong communication skills, both verbal and written, are necessary.
  • Attention to detail and excellent organizational abilities are required.
  • The ability to work independently and manage multiple claims simultaneously is vital.

Benefits:

  • A competitive salary with performance-based bonuses is offered.
  • Comprehensive health, dental, and vision benefits are provided.
  • Opportunities for career advancement and professional development are available.
  • A collaborative work environment focused on customer satisfaction is guaranteed.

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