Insurance Claims Specialist

21 hours ago

Madurai, Tamil Nadu, India beBeeClaimsResolution Full time ₹ 9,00,000 - ₹ 12,00,000
Claims Resolution Expert

The role of a Claims Resolution Expert is to oversee the entire claims resolution process from submission to final settlement.

This involves assessing claims, investigating their validity, coordinating with adjusters, and ensuring timely and fair settlements.

  • Key Responsibilities:
  • Handle the entire claims process, from reviewing submitted documentation to determining eligibility based on policy coverage.
  • Analyse data according to the provided SOPs (Standard Operating Procedures) to ensure accurate and efficient claim handling.
  • Conduct thorough investigations by collecting relevant data, conducting interviews, and working with adjusters and external experts to verify claim validity.
  • Keep policyholders and agents informed on the status of claims, provide clarity on coverage decisions, and guide them through the settlement process.
  • Negotiate settlement amounts with claimants and third parties, ensuring that settlements are fair, within policy limits, and compliant with legal standards.
  • Maintain detailed records of claims processing activities, including assessments, investigation reports, and settlement documentation.
  • Identify and flag potential fraudulent claims, collaborating with the fraud investigation team when necessary.
  • Ensure all claims are processed in adherence to company policies, industry regulations, and legal requirements.
  • Collaborate with the legal team on disputed claims or cases involving litigation to ensure proper handling.
  • Deliver exceptional customer service by addressing claim-related inquiries, resolving disputes, and ensuring a smooth claims experience for policyholders.
  • Recommend improvements to enhance efficiency and reduce claims processing time.
Requirements:
  • Strong understanding of insurance policies, claims processes, and regulatory requirements.
  • Proven negotiation and conflict resolution skills.
  • Ability to analyse complex claims data for fair settlement decisions.
  • Strong communication skills, both verbal and written.
  • Attention to detail with excellent organisational abilities.
  • Ability to work independently and manage multiple claims simultaneously.

Preferred Qualifications:

  • Certification in claims management or insurance (AIC, CPCU, or equivalent).
  • Experience handling sector-specific claims (e.g. health, agriculture, property, or auto insurance).
  • Knowledge of fraud detection and investigation techniques.
  • Experience with claims management software.

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