Insurance Policy Dispute Resolution Expert

4 days ago

Aurangabad, Maharashtra, India beBeeClaims Full time ₹ 9,00,000 - ₹ 12,00,000

Claims Settlement Specialist

We are seeking a highly skilled Claims Settlement Specialist to oversee the entire claims settlement process from submission to final resolution.

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.
  • Data Analysis: Analyze data according to the provided SOPs (Standard Operating Procedures) 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.
  • 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 and flag potential fraudulent claims, collaborating with the fraud investigation team when necessary.
  • Compliance: Ensure all claims are processed in adherence to industry regulations and legal requirements.
  • Collaboration with Legal Team: Work with the legal team on disputed claims or cases involving litigation to ensure proper handling.
  • Exceptional Customer Service: Deliver exceptional customer service by addressing claim-related inquiries, resolving disputes, and ensuring a smooth claims experience for policyholders.
  • Continuous Improvement: Recommend improvements to enhance efficiency and reduce claims processing time.

Required Skills and Qualifications:

  • Strong understanding of insurance policies, claims processes, and regulatory requirements.
  • Proven negotiation and conflict resolution skills.
  • Ability to analyze complex claims data for fair settlement decisions.
  • Strong communication skills, both verbal and written.
  • Attention to detail with excellent organizational abilities.
  • Ability to work independently and manage multiple claims simultaneously.

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