Senior Insurance Claims Resolution Professional

1 day ago

Mangalore, Karnataka, India beBeeInsurance Full time ₹ 12,00,000 - ₹ 20,00,000
Insurance Claims Resolution SpecialistJob Description:

This role entails overseeing the entire claims resolution process from submission to final closure.

Key Responsibilities:
  • Claims Management: Handle the entire claims process, reviewing submitted documentation and determining eligibility based on policy terms.
  • Data Analysis: Analyse data according to established SOPs to ensure accurate and efficient claim handling.
  • Claim Validation & Investigation: Conduct thorough investigations by collecting relevant data, conducting interviews, and collaborating 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 resolution process.
  • Settlement Negotiation: Negotiate settlement amounts with claimants and third parties, ensuring that settlements are fair, within policy limits, and compliant with regulatory 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.

The ideal candidate will possess a strong understanding of insurance policies, excellent negotiation skills, and adherence to regulatory standards. Proven experience in insurance claims handling or resolution is essential.

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