Insurance Claims Processor
3 days ago
The Role: Senior Claims Processor
This role involves handling complex, high-value, and escalated claims, ensuring strict adherence to policy wordings, regulatory guidelines, and service level agreements (SLAs).
Key Responsibilities
- **Complex Claim Adjudication**: Review, evaluate, and adjudicate high-value, complex, or escalated claims across [Specify Line of Business: e.g., Motor, Fire, Health, or Life] with precision and technical expertise.
- **Compliance & Audit**: Ensure all claim settlements comply with the Insurance Regulatory and Development Authority of India (IRDAI) regulations, internal policies, and legal requirements.
- **Process Efficiency**: Identify bottlenecks and suggest improvements in the claims workflow to enhance efficiency and customer satisfaction.
- **Stakeholder Communication**: Manage communication with policyholders, surveyors, loss adjusters, legal counsel, and reinsurers for smooth and timely claim resolution.
- **Fraud Detection**: Conduct thorough scrutiny of documents to identify and flag potential fraudulent claims.
Qualifications & Experience
Essential Requirements
- **Education & Certification**: Must possess a **Fellowship (F.I.I.I.) qualification from the Insurance Institute of India (III)**.
- **Experience**: Minimum of **[Specify Number, e.g., 5-7] years of proven, hands-on experience** in insurance claims processing/adjudication.
- **Technical Knowledge**: Comprehensive and deep understanding of insurance principles, policy wordings, and the end-to-end claims lifecycle for [Specify Line of Business].
Desired Skills
- Strong analytical, critical thinking, and problem-solving abilities.
- Exceptional written and verbal communication skills in English and [Local Language, if required].
- Proficiency in claims management software/systems and MS Office Suite.
- Proven ability to work independently, manage high-volume workloads, and meet strict deadlines.
**Benefits**:
- Competitive salary and performance-based incentives.
- Comprehensive medical and life insurance coverage.
- Opportunities for advanced professional development and leadership training.
- A collaborative and professionally stimulating work environment.
Pay: ₹35,000.00 - ₹55,000.00 per month
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