Assistant Manager - Claims

Role Purpose

The purpose of the Claims Role is to effectively manage the claims process for clients, ensuring a smooth and fair settlement of claims. The role involves reviewing and validating claims, liaising with insurers, advocating for clients' interests, and guiding them through the claims process to achieve a satisfactory outcome.

Key Expectations of the Role

1. Claims Processing and Documentation

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• Accurately review and process claims in adherence to established protocols and guidelines.
• Ensure all necessary documentation is collected and maintained for each claim, including client statements, accident reports, and relevant records.

1. Client Advocacy and Communication

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• Act as the main point of contact for clients during the claims process, providing timely updates and information.
• Advocate for clients' interests and rights, ensuring a fair and just settlement of claims.

1. Settlement or Compromised Settlement

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• Engage in substantiating the claim to the insurers to secure optimal claim settlements for clients.
• Ensure that settlements are fair and appropriate, considering policy terms, legal requirements, and clients' expectations.

1. Conflict Resolution and Customer Service

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• Address client concerns, disputes, and inquiries related to claims in a professional and timely manner.
• Facilitate conflict resolution and maintain positive client relationships throughout the claims process.

Competencies Required for the Role

1. Insurance Knowledge

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• Possesses a strong understanding of insurance policies, coverages, and claims processing.
• Familiarity with insurance regulations, industry standards, and claims-related legal aspects.

1. Communication and Interpersonal Skills

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• Demonstrates clear and effective communication, both written and verbal, to convey complex information to clients and internal stakeholders.
• Exhibits strong interpersonal skills to manage client interactions with empathy and professionalism.

1. Analytical Thinking and Problem-Solving

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• Utilizes analytical skills to assess claim details, policy information, and relevant documents to make informed decisions.
• Identifies potential challenges and develops effective solutions to ensure smooth claims processing.

1. Negotiation and Persuasion

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• Demonstrates effective negotiation skills to achieve optimal claim settlements for clients.
• Persuasively presents clients' cases and arguments to insurers, supporting claims in the best interest of clients.

1. Interpersonal Skills

   : Strong interpersonal skills, including the ability to empathize with clients, manage client expectations, and effectively communicate during the claims process.

Personal Qualifications

• Educational Background

  : A bachelor's degree in business, insurance, finance, or a related field is preferred.

• Experience

  : Prior experience in claims processing, claims handling, or related roles within the insurance industry is advantageous.

• Certifications

  : Relevant certifications in claims management or insurance claims are beneficial.

• Technology Proficiency

  : Proficient in using claims management systems, CRM software, and Microsoft Office suite (Word, Excel, Outlook, etc.).