Senior Claims Resolution Expert

3 hours ago

Mount Abu, Rajasthan, India beBeeInsurance Full time ₹ 8,00,000 - ₹ 12,00,000

Job Title: Insurance Claim Settlement Specialist

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

  • Assess claims, investigate their validity, and coordinate with adjusters.
  • Determine eligibility based on policy coverage, ensuring timely and fair settlements.
  • Analyse data according to SOPs to ensure accurate and efficient claim handling.
  • Conduct thorough investigations by collecting relevant data, conducting interviews, and working with adjusters and external experts.
  • Negotiate settlement amounts with claimants and third parties, ensuring compliance with legal standards.
  • Maintain detailed records of claims processing activities.
  • Identify and flag potential fraudulent claims, collaborating with the fraud investigation team when necessary.

The ideal candidate will possess a strong understanding of insurance policies, excellent negotiation skills, and adherence to company standards and legal regulations.

Key Responsibilities:

  • Claims Processing: Handle the entire claims process, from reviewing submitted documentation to determining eligibility.
  • Data Analysis: Analyse data according to provided 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.
  • Client Communication: Keep policyholders informed on the status of claims and provide clarity on coverage decisions.
  • Settlement Negotiation: Negotiate settlement amounts with claimants and third parties, ensuring compliance with legal standards.
  • Documentation & Reporting: Maintain detailed records of claims processing activities.
  • Fraud Detection: Identify and flag potential fraudulent claims, collaborating with the fraud investigation team when necessary.

Required Qualifications:

  • A solid 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.

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.

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