Insurance Claim Specialist Leader
3 days ago
We seek an experienced professional to oversee the entire insurance claims process from submission to resolution.
The ideal candidate will assess claims, investigate their validity, and coordinate with adjusters to ensure timely and fair settlements. Strong negotiation skills and adherence to regulatory standards are essential for success in this role.
Key Responsibilities:- Claims Management:
- Handle the claims process, from reviewing submitted documentation to determining eligibility based on policy coverage.
- Data Analysis:
- Analyse data according to provided SOPs 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 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 regulatory requirements and industry standards.
- 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.
- Strong understanding of insurance policies, claims processes, and regulatory requirements.
- Proven negotiation and conflict resolution skills.
- Ability to analyse complex claims data for fair settlement decisions.
- Strong communication skills, both verbal and written.
- Attention to detail with excellent organisational abilities.
- Ability to work independently and manage multiple claims simultaneously.
- 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.
- Experience with claims management software.
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