
Claims Resolution Expert
1 day ago
We are seeking a skilled Insurance Claims Resolution Professional to oversee the entire claims resolution process from submission to final settlement. The ideal candidate will assess claims, investigate their validity, and ensure timely and fair settlements.
Critical Claims Evaluation: Conduct thorough evaluations of submitted claims, reviewing documentation and determining eligibility based on policy coverage.
Data Analysis and Assessment: Analyze data according to established SOPs (Standard Operating Procedures) to ensure accurate and efficient claim handling.
Fraud Detection and Investigation: Identify potential fraudulent claims through rigorous investigation and collaboration with experts when necessary.
Claims Communication and Negotiation: Effectively communicate with policyholders and agents regarding claim status, provide clarity on coverage decisions, and negotiate fair settlements.
Documentation and Reporting: Maintain comprehensive records of claims processing activities, including assessments, investigation reports, and settlement documentation.
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.
Excellent communication skills, both verbal and written.
Attention to detail with excellent organizational abilities.
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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Insurance Claim Settlement Specialist
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Health Insurance Claims Manager
3 days ago
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