
Insurance Claims Resolution Professional
11 hours ago
Insurance Claims Specialist Job Description
We are seeking a seasoned insurance claims specialist to oversee the entire claims process from submission to resolution. The ideal candidate will evaluate claims, investigate their validity, collaborate with adjusters, and ensure timely and fair settlements.
Key Responsibilities:
- Claims Processing: Manage the entire claims process, from reviewing submitted documentation to determining eligibility based on policy coverage.
- Data Analysis: Analyze data according to provided Standard Operating Procedures (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 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.
Requirements:
- Bachelor's degree in a related field.
- Minimum 3 years of experience in claims processing or a related field.
- Excellent communication and analytical skills.
- Able to work under pressure and meet deadlines.
- Knowledge of industry regulations and legal standards.
What We Offer:
- Competitive salary and benefits package.
- Opportunities for career growth and professional development.
- A dynamic and supportive work environment.
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