Insurance Claims Resolution Specialist

2 weeks ago

Morādābād, Uttar Pradesh, India beBeeClaims Full time ₹ 15,00,000 - ₹ 20,00,000
Insurance Claim Settlement Expert

The ideal candidate will assess claims, investigate their validity, coordinate with adjusters and ensure timely and fair settlements.

Key Responsibilities:
  • Claims Processing:
  • Handle the entire claims process from reviewing submitted documentation to determining eligibility based on policy coverage, using analytical skills and business acumen.
  • Data Analysis:
  • Analyse data according to Standard Operating Procedures (SOPs) to ensure accurate and efficient claim handling.
  • Claim Validation & Investigation:
  • Conduct thorough investigations by collecting relevant data, conducting interviews, and working with adjusters and external experts to verify claim validity, ensuring compliance with industry regulations.
  • Client Communication:
  • Keep policyholders and agents informed on the status of claims, provide clarity on coverage decisions, and guide them through the settlement process, delivering exceptional customer service.
  • Settlement Negotiation:
  • Negotiate settlement amounts with claimants and third parties, ensuring that settlements are fair, within policy limits, and compliant with legal standards, utilizing negotiation and conflict resolution skills.
  • Documentation & Reporting:
  • Maintain detailed records of claims processing activities, including assessments, investigation reports, and settlement documentation, adhering to company policies and regulatory requirements.
  • Fraud Detection:
  • Identify and flag potential fraudulent claims, collaborating with the fraud investigation team when necessary, to prevent financial losses and maintain a strong reputation.
  • Compliance:
  • Ensure all claims are processed in adherence to company policies, industry regulations, and legal requirements, upholding the highest standards of integrity and professionalism.
  • Coordination with Legal Team:
  • Collaborate with the legal team on disputed claims or cases involving litigation to ensure proper handling and minimize risks.
  • Continuous Improvement:
  • Recommend improvements to enhance efficiency and reduce claims processing time, utilizing data analysis and business insights to drive growth and excellence.

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