Claims Analyst - SeaInsure

Job Description

Claims Evaluation and Processing

• Utilize our CRM system as the primary system for claims management and processing.
• Review and assess claims documentation for accuracy and completeness.
• Analyze coverage and liability based on policy terms and conditions.
• Determine the legitimacy of claims and identify potential fraudulent activities.
• Calculate claim payouts and ensure timely and accurate processing of claims.
  
  

• Coordinate with the Product Management Team to suggest Bytesforce system enhancements for claims processes
• Support quality assurance and user acceptance testing (UAT) efforts, working with relevant stakeholders to align with system and customer requirements.
  
  

• Work alongside business and cross-functional teams to constantly optimize operational processes and improve the product experience for both internal and external users.
• Identify and suggest opportunities for process improvements and increased efficiency.
  
  

• A Bachelor’s Degree in Finance, Commerce or any medical field
• Minimum of 1 year of experience in a Life / general Insurance firm.
• Good understanding of the local life and health insurance product market.
• Understanding of health-related claims and overall Filipino health service systems (i.e. public / private healthcare, clinics, other providers) network
• Good understanding of local regulatory requirements, particularly from a claims perspective