Insurance Claim Settlement Specialist

Job Title:

Location:

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Experience Required:

Education:

Preferred Qualification:

Job Overview:

Insurance Claim Settlement Specialist

Key Responsibilities:

• Claims Processing:

• Handle the entire claims process, from reviewing submitted documentation to determining eligibility based on policy coverage.

• Data Analysis:

• Analyse data according to the provided SOPs (Standard Operating Procedures) to ensure accurate and efficient claim handling.

• Claim Validation & Investigation:

• Conduct thorough investigations by collecting relevant data, conducting interviews, and working with adjusters and external experts to verify claim validity.

• Client Communication:

• Keep policyholders and agents informed on the status of claims, provide clarity on coverage decisions, and guide them through the settlement process.

• Settlement Negotiation:

• Negotiate settlement amounts with claimants and third parties, ensuring that settlements are fair, within policy limits, and compliant with legal standards.

• Documentation & Reporting:

• Maintain detailed records of claims processing activities, including assessments, investigation reports, and settlement documentation.

• Fraud Detection:

• Identify and flag potential fraudulent claims, collaborating with the fraud investigation team when necessary.

• Compliance:

• Ensure all claims are processed in adherence to company policies, industry regulations, and legal requirements.

• Coordination with Legal Team:

• Collaborate with the legal team on disputed claims or cases involving litigation to ensure proper handling.

• Customer Service:

• Deliver exceptional customer service by addressing claim-related inquiries, resolving disputes, and ensuring a smooth claims experience for policyholders.

• Continuous Improvement:

• Recommend improvements to enhance efficiency and reduce claims processing time.

Key Qualifications:

• Strong understanding of insurance policies, claims processes, and regulatory requirements.
• Proven negotiation and conflict resolution skills.
• Ability to analyze complex claims data for fair settlement decisions.
• Strong communication skills, both verbal and written.
• Attention to detail with excellent organizational abilities.
• Ability to work independently and manage multiple claims simultaneously.

Preferred Qualifications:

• Certification in claims management or insurance (AIC, CPCU, or equivalent).
• Experience handling sector-specific claims (e.g., health, agriculture, property, or auto insurance).
• Knowledge of fraud detection and investigation techniques.
• Experience with claims management software.

What We Offer:

• Competitive salary with performance-based bonuses.
• Comprehensive health, dental, and vision benefits.
• Opportunities for career advancement and professional development.
• Collaborative work environment focused on customer satisfaction.