
Settlement Claims Professional
6 hours ago
We are seeking an experienced professional to manage the entire claims settlement process from submission to final resolution.
- Main Responsibilities:
- Claims Processing: Handle 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.
Key Qualifications:
- 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.
- Strong communication skills, both verbal and written.
- Attention to detail with excellent organizational abilities.
- Ability to work independently and manage multiple claims simultaneously.
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