Insurance Claim Resolution Expert

12 hours ago

Aligarh, Uttar Pradesh, India beBeeResolution Full time ₹ 8,00,000 - ₹ 12,00,000
Job Title: Insurance Claim Resolution Expert

The primary role of an Insurance Claim Resolution Expert is to effectively manage the entire claims process from submission to final resolution.

  • Key Responsibilities:
  • Claims Processing: This entails handling the entire claims process, commencing with thorough documentation review and culminating in accurate determination of eligibility based on policy coverage.
  • Data Analysis: Detailed data analysis must be performed according to established SOPs (Standard Operating Procedures) to ensure seamless claim handling.
  • Claim Validation & Investigation: In-depth investigations are conducted by collecting relevant data, conducting interviews, and collaborating with adjusters and external experts to verify claim validity.
  • Client Communication: Policyholders and agents are kept informed on the status of claims, provided with clarity on coverage decisions, and guided through the settlement process.
  • Negotiation: Negotiations for settlement amounts are conducted with claimants and third parties, ensuring that settlements are fair, within policy limits, and compliant with legal standards.
  • Documentation & Reporting: Thorough records are maintained of claims processing activities, including assessments, investigation reports, and settlement documentation.
  • Fraud Detection: Potential fraudulent claims are identified and flagged, with collaboration with the fraud investigation team when necessary.
  • Compliance: Claims are processed in adherence to company policies, industry regulations, and legal requirements.
  • Coordination with Legal Team: Collaboration with the legal team is essential for disputed claims or cases involving litigation to ensure proper handling.
  • Customer Service: Exceptional customer service is delivered by addressing claim-related inquiries, resolving disputes, and ensuring a smooth claims experience for policyholders.
  • Continuous Improvement: Recommendations for enhancements to efficiency and reduced claims processing time are made.

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