
Insurance Claims Resolution Specialist
2 days ago
The claims settlement professional will oversee the entire claims settlement process from submission to final resolution. This involves assessing claims, investigating their validity, coordinating with adjusters, and ensuring timely and fair settlements.
Key Responsibilities Include:
- Claims Processing
- Review submitted documentation to determine eligibility based on policy coverage.
- Reviewing 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
- Keeping policyholders and agents informed on the status of claims, providing clarity on coverage decisions, and guiding them through the settlement process.
- Settlement Negotiation
- Negotiating settlement amounts with claimants and third parties, ensuring that settlements are fair, within policy limits, and compliant with legal standards.
- Documentation & Reporting
- Maintaining detailed records of claims processing activities, including assessments, investigation reports, and settlement documentation.
- Fraud Detection
- Identifying and flagging potential fraudulent claims, collaborating with the fraud investigation team when necessary.
- Compliance
- Ensuring all claims are processed in adherence to industry regulations and legal requirements.
- Coordination with Legal Team
- Collaborating with the legal team on disputed claims or cases involving litigation to ensure proper handling.
- Customer Service
- Delivering exceptional customer service by addressing claim-related inquiries, resolving disputes, and ensuring a smooth claims experience for policyholders.
- Continuous Improvement
- Recommending improvements to enhance efficiency and reduce claims processing time.
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