Senior Claims Resolution Expert

2 days ago

Ajmer, Rajasthan, India beBeeInsurance Full time ₹ 8,00,000 - ₹ 15,00,000
Job Title

Insurance Claim Settlement Specialist

Description of the Role

This role requires a strong understanding of insurance policies and claims processes to ensure timely and fair settlements. The successful candidate will be responsible for managing the entire claims settlement process from submission to final resolution.

  1. The Insurance Claim Settlement Specialist will assess claims, investigate their validity, coordinate with adjusters, and ensure timely and fair settlements are essential duties in this role.
  2. A strong understanding of insurance policies, excellent negotiation skills, and adherence to company standards and legal regulations are necessary for success.
Key Responsibilities
  • Claims Processing: Handle the entire claims process, reviewing submitted documentation and determining eligibility based on policy coverage.
  • Data Analysis: Analyse data according to Standard Operating Procedures (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: Keep policyholders and agents informed on the status of claims, providing clarity on coverage decisions and guiding 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 company 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.
  • Continuous Improvement: Recommend improvements to enhance efficiency and reduce claims processing time.
Required Skills and Qualifications
  • 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.
Benefits
  • Competitive salary with performance-based bonuses.
  • Comprehensive health, dental, and vision benefits.
  • Opportunities for career advancement and professional development.
  • Collaborative work environment focused on customer satisfaction.

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