Specialist - Insurance Claims 20O25

The Specialist - Insurance Claims is a critical role within our organization, responsible for managing and processing insurance claims efficiently and accurately. This position demands a detail-oriented individual who can navigate complex insurance processes and deliver exceptional customer service. The Specialist will interact with claimants, insurers, and other stakeholders to ensure claims are settled promptly and fairly. A thorough understanding of insurance regulations and excellent analytical skills are essential. The ideal candidate will also exhibit excellent communication skills, both written and verbal, to effectively explain claim decisions and procedures. If you are passionate about insurance and looking for a challenging yet rewarding career, this position could be your perfect match.

Responsibilities

• Evaluate insurance claims to determine validity, settlement, and payment obligations.
• Gather and analyze policyholder information and supporting claim documents thoroughly.
• Communicate with claimants, ensuring clarity in all aspects of the claims process.
• Interpret and apply insurance policies and laws to process claims correctly.
• Manage a portfolio of claims, ensuring each is processed in a timely manner.
• Coordinate with medical professionals and other experts for claim assessments.
• Resolve claim discrepancies by analyzing and verifying supplemental information.
• Prepare and maintain claim files which are comprehensive and organized.
• Stay updated on industry trends and regulations impacting claims processes.
• Handle customer inquiries regarding pending claims and policy coverages.
• Determine root causes of claim rejections and implement strategies for improvement.
• Engage in continuous learning to enhance knowledge of new and existing insurance products.

Requirements

• Bachelor's degree in Insurance, Business Administration, or a related field required.
• Minimum of 3 years of experience in insurance claims processing or a related field.
• Strong understanding of insurance processes and relevant regulations necessary.
• Excellent analytical skills to assess complex claim details effectively.
• Proficient in using claims management software and other relevant technology.
• Exceptional communication skills to interact with various stakeholders professionally.
• Attention to detail and ability to work under pressure to meet deadlines.