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Senior Claims Specialist

2 weeks ago

Bengaluru, Karnataka, India beBeeClaims Full time ₹ 30,00,000 - ₹ 35,00,000

Role Overview

The purpose of this position is to effectively manage the claims process for clients, ensuring a smooth and fair settlement of claims. The role involves reviewing and validating claims, liaising with insurers, advocating for clients' interests, and guiding them through the claims process to achieve a satisfactory outcome.

Main Responsibilities

  • Claims Processing: Accurately review and process claims in adherence to established protocols and guidelines.
  • Documentation: Ensure all necessary documentation is collected and maintained for each claim, including client statements, accident reports, and relevant records.
  1. Client Advocacy and Communication:
  • Act as the main point of contact for clients during the claims process, providing timely updates and information.
  • Advocate for clients' interests and rights, ensuring a fair and just settlement of claims.
  1. Settlement or Compromised Settlement:
  • Engage in substantiating the claim to the insurers to secure optimal claim settlements for clients.
  • Ensure that settlements are fair and appropriate, considering policy terms, legal requirements, and clients' expectations.
  1. Conflict Resolution and Customer Service:
  • Address client concerns, disputes, and inquiries related to claims in a professional and timely manner.
  • Facilitate conflict resolution and maintain positive client relationships throughout the claims process.

Key Competencies Required for the Role:

  1. Insurance Knowledge:
  • Possesses a strong understanding of insurance policies, coverages, and claims processing.
  • Familiarity with insurance regulations, industry standards, and claims-related legal aspects.
  1. Communication and Interpersonal Skills:
  • Demonstrates clear and effective communication, both written and verbal, to convey complex information to clients and internal stakeholders.
  • Exhibits strong interpersonal skills to manage client interactions with empathy and professionalism.
  1. Analytical Thinking and Problem-Solving:
  • Utilizes analytical skills to assess claim details, policy information, and relevant documents to make informed decisions.
  • Identifies potential challenges and develops effective solutions to ensure smooth claims processing.
  1. Negotiation and Persuasion:
  • Demonstrates effective negotiation skills to achieve optimal claim settlements for clients.
  • Persuasively presents clients' cases and arguments to insurers, supporting claims in the best interest of clients.

Personal Qualifications:

  • Educational Background: A bachelor's degree in business, insurance, finance, or a related field is preferred.
  • Experience: Prior 10 yrs of work experience in claims processing, claims handling, or related roles within the insurance industry is advantageous.
  • Certifications: Relevant certifications in claims management or insurance claims are beneficial.
  • Technology Proficiency: Proficient in using claims management systems, CRM software, and Microsoft Office suite (Word, Excel, Outlook, etc.).