Insurance Claims Specialist
5 days ago
We are seeking a skilled Claims Resolution Specialist to join our team. In this role, you will be responsible for processing claims, providing recommendations and final decisions based on set authority limits approved by management.
About the Role
This position involves coordinating with team members and other stakeholders to ensure timely claims resolution. You will be expected to countercheck and provide recommendations or final decisions on referred claims cases from junior claims assessors, including those processed by customer service staff handling claims transactions.
Key Responsibilities:
- Coordinate with team members and other stakeholders to ensure timely claims resolution
- Countercheck and provide recommendations or final decisions on referred claims cases
- Investigate and evaluate claims to determine their validity, including gathering relevant documentation, medical records, and other supporting materials
- Makes necessary recommendations on claims or makes final decisions, in accordance with set authority limits
- Ensure proper documentation of cases evaluated and maintain confidentiality of claims records
- Provide claimants with appropriate explanations of claims benefits that may not be covered or payable
- Assess additional or new information on denied claims or claims with limited benefits payout and determine if there are grounds for consideration or revised recommendations
- Coordinates with third-party administrations/contractors, adjusters, and other service providers to finalize claims process
- Participate and contribute to process improvements and initiatives to enhance team efficiency
- Conduct learning sessions for claims team as required
- Represent organization in IC mediations, court hearings as required, involving cases appraised within approval limits
- Perform other duties assigned by claims assessment lead or claims manager to meet departmental and company objectives
Requirements:
- Graduate of bachelor's degree course (preferably with medical background)
- At least 5 years of work experience in insurance claims processing
- Knowledge of life and general insurance products, claims processes, and regulatory requirements
- Experience with claims management systems and related software
- Proficient in Microsoft Office applications
- Strong analytical, judgement, comprehension, and conceptual thinking skills
- Detail-oriented, organized, systematic, able to work under pressure and multi-task
- Possesses effective interpersonal relationship skills and is a team player
- Strong client service orientation and good sense of urgency
What We Offer:
We offer a range of benefits to support your career development and well-being. Our organization is committed to helping employees build successful careers and live healthier, longer, better lives.
You must provide all requested information to be considered for this opportunity. Failure to do so may influence the outcome of your application. Ensure accuracy and update of submitted information.
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