Lead Claims Resolution Professional

3 hours ago

Rajahmundry, Andhra Pradesh, India beBeeInsurance Full time ₹ 40,00,000 - ₹ 80,00,000

Job Title: Insurance Claim Settlement Specialist

We are looking for an experienced professional to manage 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. A strong understanding of insurance policies, excellent negotiation skills, and adherence to legal regulations are essential for success in this role.

Key Responsibilities:

  • Claims Processing: Handle 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 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.
  • Customer Service: Deliver exceptional customer service by addressing claim-related inquiries, resolving disputes, and ensuring a smooth claims experience for policyholders.
  • Continuous Improvement: Recommend improvements to enhance efficiency and reduce claims processing time.

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