
Chief Claims Resolution Professional
8 hours ago
Job Overview
Insurance Claim Settlement Specialists are highly skilled professionals responsible for managing the entire claims settlement process from submission to final resolution.
Key Responsibilities:- Claims Management:
- Assess and investigate claims, coordinate with adjusters, and ensure timely and fair settlements.
- Data Analysis:
- Analyse data according to provided 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.
- Client Communication:
- Keep policyholders and agents informed on the status of claims, provide clarity on coverage decisions, and guide them through the settlement process.
- Negotiation & Documentation:
- Negotiate settlement amounts with claimants and third parties, ensuring that settlements are fair, within policy limits, and compliant with legal standards. Maintain detailed records of claims processing activities.
- Fraud Detection & Compliance:
- Identify and flag potential fraudulent claims, collaborating with the fraud investigation team when necessary. Ensure all claims are processed in adherence to industry regulations and legal requirements.
- Coordination & Customer Service:
- Collaborate with the legal team on disputed claims or cases involving litigation to ensure proper handling. Deliver exceptional customer service by addressing claim-related inquiries, resolving disputes, and ensuring a smooth claims experience for policyholders.
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