Insurance Claims Resolution Professional

2 days ago


Jaipur, Rajasthan, India beBeeClaim Full time ₹ 10,05,510 - ₹ 15,70,065

Structured Claim Resolution Expertise

1. Role Overview:

The Insurance Claim Settlement Specialist plays a pivotal role in ensuring seamless claims processing, upholding company standards, and adhering to legal regulations.

2. Key Responsibilities:

  • Claims Processing: Handle the entire claims process, from reviewing submitted documentation to determining eligibility based on policy coverage, ensuring timely resolution of claims.
  • Data Analysis: Analyze data according to provided SOPs (Standard Operating Procedures) to guarantee accurate and efficient claim handling.
  • Claim Validation & Investigation: Conduct thorough investigations by collecting relevant data, conducting interviews, and collaborating with adjusters and external experts to verify claim validity.
  • Client Communication: Maintain open communication with policyholders and agents regarding claim status, provide clarity on coverage decisions, and guide them through the settlement process.
  • Settlement Negotiation: Negotiate fair and compliant settlement amounts with claimants and third parties, ensuring settlements align with policy limits and 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.
  • Collaboration with Legal Team: Work closely 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.

3. Benefits: As an Insurance Claim Settlement Specialist, you will enjoy opportunities for professional growth, competitive compensation, and a dynamic work environment.

4. Required Skills: To excel in this role, you should possess strong analytical skills, excellent communication abilities, and a deep understanding of insurance policies and regulations.



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