Expert Insurance Claim Resolver

2 days ago

Bareilly, Uttar Pradesh, India beBeeInsurance Full time ₹ 9,00,000 - ₹ 12,00,000
Claims Settlement Specialist Role

We are seeking an experienced Claims Settlement Specialist to oversee the entire claims settlement process from submission to final resolution.

The ideal candidate will assess claims, investigate their validity, coordinate with adjusters, and ensure timely and fair settlements.

Key Responsibilities:
  • Claims Processing: Manage 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 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.
Required Skills & Qualifications:
  • A strong understanding of insurance policies, claims processes, and regulatory requirements.
  • Proven negotiation and conflict resolution skills.
  • The ability to analyse complex claims data for fair settlement decisions.
  • Strong communication skills, both verbal and written.
  • Attention to detail with excellent organisational abilities.
Benefits:
  • A competitive salary with performance-based bonuses.
  • Comprehensive health, dental, and vision benefits.
  • Opportunities for career advancement and professional development.
  • A collaborative work environment focused on customer satisfaction.

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