Insurance Claims Resolution Professional

2 days ago

Guntur, Andhra Pradesh, India beBeeNegotiation Full time ₹ 9,00,000 - ₹ 12,00,000
Insurance Claim Settlement Specialist

We are seeking an experienced insurance claim settlement professional to oversee the entire claims settlement process from submission to final resolution.

This role requires a strong understanding of insurance policies, excellent negotiation skills, and adherence to industry standards and legal regulations.

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

  • Key Responsibilities:
  • Claims Processing:
  • Analyze data according to provided SOPs (Standard Operating Procedures) to ensure accurate and efficient claim handling.
  • Data Analysis:
  • Analyze complex claims data for fair settlement decisions.
  • 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:
  • 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 policies, industry regulations, and legal requirements.
  • Coordination with Legal Team:
  • Collaborate with the legal team on disputed claims or cases involving litigation to ensure proper handling.
  • Customer Service:
  • Deliver exceptional customer service by addressing claim-related inquiries, resolving disputes, and ensuring a smooth claims experience for policyholders.

Required Skills and Qualifications:

  • Strong understanding of insurance policies and claims processes.
  • 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.

Benefits:

  • Certification in claims management or insurance is a plus.
  • Experience handling sector-specific claims is beneficial.
  • Knowledge of fraud detection and investigation techniques is a valuable asset.

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