Insurance Claims Associate (225-723)

An Insurance Claims Associate plays a crucial role in the insurance industry, providing important support and service to policyholders by ensuring that claims are processed thoroughly and efficiently. This position involves reviewing insurance claims, gathering necessary information, and making decisions based on policy terms and conditions. An Insurance Claims Associate is responsible for communicating with various stakeholders, including claimants, attorneys, and medical professionals, to facilitate the claims process. The role requires strong analytical skills, attention to detail, and excellent communication abilities. As an Insurance Claims Associate, you will be helping individuals navigate their claims, providing them clarity and assistance in understanding their insurance benefits, and ensuring that legitimate claims are processed and paid timely and accurately.

Responsibilities

• Review and process insurance claims submitted by policyholders in a timely manner.
• Gather additional information from claimants and relevant parties to support claim assessments.
• Analyze and interpret insurance policy terms and coverage to determine claim eligibility.
• Communicate with policyholders, providing them with updates and information about their claims.
• Collaborate with internal departments to ensure claims are processed accurately and efficiently.
• Maintain detailed and organized records of claims and communications for reference.
• Identify suspicious or fraudulent claims and escalate them to appropriate departments.
• Ensure compliance with insurance regulations and company policies during claim processing.
• Provide exceptional customer service and resolve policyholder inquiries effectively.
• Prepare and send accurate settlement offers and explain claim decisions to claimants.
• Participate in team meetings and contribute to process improvements through feedback.
• Stay informed about industry trends and updates to maintain expertise in the field.

Requirements

• High school diploma or equivalent; associate degree preferred in related field.
• Minimum of 1-2 years of experience in insurance claims or related field required.
• Strong attention to detail and ability to analyze complex information accurately.
• Excellent communication skills with the ability to explain complex topics clearly.
• Proficient in using computer systems and software related to insurance claims processing.
• Ability to work independently and manage multiple claims with effective time management.
• Knowledge and understanding of insurance regulations and standard industry practices.