Insurance Claim Settlement Specialist

12 hours ago

Mumbai, India Swan Corp Full time

Job Title: Insurance Claim Settlement Specialist

Location: Mumbai/Remote

Employment Type: Full-Time

Experience Required: 2+ years in insurance claims handling or settlement

Education: Bachelor's degree in Insurance, Risk Management, Business Administration, or a related field.

Preferred Qualification: Proficient in Hindi/Marathi

Job Overview:

We are looking for an experienced Insurance Claim Settlement Specialist 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 company standards and 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 the 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 company policies, 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.

Preferred Qualifications:

  • 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.

What We Offer:

  • Competitive salary with performance-based bonuses.
  • Comprehensive health, dental, and vision benefits.
  • Opportunities for career advancement and professional development.
  • Collaborative work environment focused on customer satisfaction.

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