Roles and Responsibilities:
- Process claims fairly and efficiently by reviewing claim documents, verifying policy terms, and following company guidelines to ensure timely and accurate settlements.
- Assess the validity of claims by analyzing product type, policy conditions, and supporting documentation to determine eligibility and prevent fraudulent claims.
- Handle policyholder and broker inquiries by providing accurate information, clarifying policy coverage, and maintaining professional communication to uphold excellent customer service and meet service level agreements.
- Apply claim assessment criteria within designated limits by referencing policy terms and company guidelines while escalating high value claims to ensure consistency and fairness in settlements.
- Follow up on pending claims and required documentation by tracking outstanding reserves, requesting necessary data, and updating claim files to maintain accurate records and ensure timely claim resolution.
- Ensure compliance with claims assessment best practices by following standard procedures, coordinating salvage handling, and monitoring legal case follow-ups to reduce risks and optimize claim outcomes.
- Maintain high standards of file documentation by organizing claim records, ensuring accuracy, and adhering to regulatory requirements to support transparency and facilitate audits.
Pre-requisites (Education, Professional Experience):
- 1 3 years of experience in the insurance field.
- Bachelor's degree in business administration, or a related field
- Professional certification in insurance or claims assessment (e.g., CII, AIC) is an advantage
