Claim Processing Executive (225-905)

The Claim Processing Executive plays a pivotal role in the insurance sector by managing and processing claims efficiently and accurately. This position involves reviewing and validating insurance claims submitted by clients, ensuring that all necessary documentation is present and correct, and managing claim records. The role is customer-focused and requires excellent communication skills to liaise with clients and other departments effectively. The Claim Processing Executive must be detail-oriented and possess strong analytical skills to evaluate and process claims against policy terms and conditions accurately. Being part of a team that upholds integrity and professionalism, the role is crucial for maintaining the trust and satisfaction of clients while safeguarding the company’s financial interests.

Responsibilities

• Review and process insurance claims submitted by clients with attention to detail.
• Evaluate all submitted documents against policy terms to validate claim authenticity.
• Ensure all claims are settled in a timely manner, adhering to company protocols.
• Collaborate with other departments for thorough investigations into suspect claims.
• Coordinate with insurance adjusters and appraisers when physical inspection is required.
• Maintain clear and comprehensive records of claims processed for audit purposes.
• Communicate claim decisions to clients, providing detailed explanations as required.
• Handle client inquiries and provide timely updates on claim status and progress.
• Identify potential fraud and escalate cases to the fraud prevention team when necessary.
• Assist in the development and improvement of claims processing procedures and policies.
• Ensure compliance with all regulatory requirements and internal company guidelines.
• Participate in team meetings to discuss and review complex claim cases as needed.

Requirements

• Bachelor’s degree in Business Administration, Finance, or related field preferred.
• Proven experience in claims processing or a similar role in the insurance industry.
• Strong analytical skills with the ability to interpret and analyze data effectively.
• Excellent organizational skills with high attention to detail and accuracy.
• Proficiency with claims processing software and Microsoft Office Suite.
• Effective communication skills, both written and verbal, for client interactions.
• Ability to handle sensitive information with confidentiality and professional integrity.