
Insurance Claims Resolution Manager
1 day ago
We are seeking a highly skilled and experienced Claims Resolution Manager to oversee the entire claims settlement process, ensuring seamless execution from submission to final resolution.
Key Responsibilities:
- Oversee the complete claims lifecycle, reviewing submitted documentation, determining eligibility based on policy coverage, and guiding claimants through the settlement process.
- Conduct thorough investigations by collecting relevant data, conducting interviews, and working with adjusters and external experts to verify claim validity.
- Analyze data according to established Standard Operating Procedures (SOPs) to ensure accurate and efficient claim handling.
- Communicate clearly with policyholders, agents, and third parties regarding claim status, coverage decisions, and settlement amounts.
- Negotiate settlement amounts with claimants and third parties, ensuring fairness, compliance with policy limits, and adherence to legal standards.
- Maintain detailed records of claims processing activities, including assessments, investigation reports, and settlement documentation.
- Identify potential fraudulent claims and collaborate with the fraud investigation team as needed.
- Ensure all claims are processed in accordance with company policies, industry regulations, and legal requirements.
- Collaborate with the legal team on disputed claims or cases involving litigation to ensure proper handling.
- Deliver exceptional customer service by addressing claim-related inquiries, resolving disputes, and ensuring a smooth claims experience for policyholders.
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