Specialist - Insurance Claims 04D25

The Specialist - Insurance Claims (04D25) is a dynamic position that plays a critical role in the efficient management and resolution of insurance claims. Designed for those with a keen eye for detail and a strong commitment to customer service, this role requires a person who excels in communication and possesses comprehensive knowledge of industry practices and regulations. As a Specialist, you will be responsible for investigating, assessing, and processing insurance claims in a timely and accurate manner. This role is indispensable for ensuring the satisfaction of our clients by providing them with fair, transparent, and efficient claims resolutions. Working collaboratively with other professionals, you’ll use your expertise to maintain seamless operations and support the company’s overall mission to deliver high-quality service and reliability.

Responsibilities

• Evaluate and process insurance claims by assessing the validity and coverage.
• Communicate with policyholders to collect pertinent information for claims assessment.
• Coordinate with legal and financial advisors to ensure compliance with industry regulations.
• Analyze documentation for accuracy and completeness to expedite claims decisions.
• Conduct thorough investigations to verify facts and determine liability and damages.
• Negotiate settlements with policyholders and external stakeholders to achieve fair outcomes.
• Maintain up-to-date records and reports on claims statuses and case progressions.
• Serve as a subject matter expert to provide guidance to other claims professionals.
• Collaborate with other departments to resolve complex cases and facilitate client satisfaction.
• Identify potential fraud cases and report findings to appropriate units for further action.
• Ensure all claims are processed in accordance with legal requirements and company policies.
• Develop and implement best practices to enhance claims processes and customer service.

Requirements

• Bachelor's degree in Insurance, Business, Finance, or a related field is preferred.
• Minimum of three years of experience in insurance claims processing or management.
• Strong knowledge of insurance policies, regulations, and claims handling procedures.
• Excellent analytical and problem-solving skills to assess complex claims efficiently.
• Exceptional communication and negotiation abilities to liaise with clients and stakeholders.
• Detail-oriented with outstanding organizational skills to manage multiple claims simultaneously.
• Proficiency in relevant software and tools used in the insurance industry.