Claims Examiner

2 weeks ago


Makati City, National Capital Region, Philippines Pioneer Insurance Full time ₱300,000 - ₱600,000 per year

Job Purpose

The Claims Evaluator/Examiner is responsible for investigating, evaluating, and processing non-life insurance claims in accordance with company policies, procedures, and regulatory requirements. The role ensures timely, fair, and accurate settlement of claims while maintaining excellent customer service and minimizing company losses.

Roles and Responsibilities

  • Receive, review, and acknowledge reported claims from policyholders, agents, or intermediaries.
  • Investigate claims by gathering relevant documentation such as police reports, photos, repair estimates, and witness statements.
  • Assess coverage, liability, and damages in accordance with policy terms and conditions.
  • Coordinate and communicate with clients, agents, service providers, and third-party adjusters to facilitate claim resolution.
  • Recommend appropriate settlements and negotiate with claimants when necessary.
  • Prepare claims reports and maintain accurate documentation in the claims management system.
  • Ensure compliance with company guidelines, insurance laws, and regulatory standards.
  • Identify potential cases of fraud or subrogation opportunities.
  • Assist in the continuous improvement of claims processes and customer experience.

Qualifications

  • Bachelor's degree in business administration, Finance, or any related field.
  • At least
    1–3 years of experience
    in claims processing within a
    non-life insurance company
    (motor, property, or other general insurance lines).
  • Good communication and customer service skills.
  • Proficient in MS Office applications and claims management systems.
  • Willing to work in a full on-site setup
  • Strong communication and people skills
  • Comfortable working in a fast-paced environment
  • Strong organizational skills
  • Attention to detail
  • Passion in customer service

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