Senior Claims Settlement Professional

4 days ago

Bengaluru, Karnataka, India beBeeNegotiation Full time ₹ 60,00,000 - ₹ 85,00,000
Job Title:

Insurance Claims Processor

About the Role:

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

Key Responsibilities:
  • Claims Processing:
    • Handle the entire claims process, from reviewing submitted documentation to determining eligibility based on policy coverage.
  • Data Analysis:
    • Analyse data according to 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.
  • 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.
  • Continuous Improvement:
    • 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 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.
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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