Principal Duties & Responsibilities
- Negotiate with corporate customers on settlement amounts, terms and recovery actions in accordance with organization policies and procedures as well as applicable laws and regulations
- Communicate all claims decisions in a timely and appropriate manner and ensure that communication during the assessment process is regular, timely, and clearly documented.
- Determine if technical and/or high-value claims should be accepted based on results of claims analysis and reports from service providers
- Determine settlement amounts for technical and/or high-value insurance claims based on investigation outcomes
- Assess potential high-value fraudulent claims by evaluating documents and information collected against common indicators of frauds
- Interpret policy wordings and conditions to determine the validity of claims and advises the claimant accordingly
- Ensure claim matters are handled according to customer service standards and defined customer experience policies
- Review Key Performance Indicators (KPIs) relevant to each stage of the insurance claims process and propose recommendations to increase efficiency
- Identify claims trends to propose product design enhancements
- Determine appropriate modifications to business processes to ensure seamless transition and minimize resistance for claims handling
- Ensure accuracy of records and adherence to internal controls
Education and Work Experience
- Bachelor’s Degree in Insurance or any related discipline
- Minimum of 7-9 years’ experience in claims with at least 3 years leading a team.
- Must possess a CIIN membership.
Required Skills and Competencies
· Demonstrate technical claims knowledge and experience
- Able to provide recommendations to improve claims operations
- Able to analyze claims records to evaluate efficiency and effectiveness of claims operations against predefined performance standards
- Able to improve efficiencies, effectiveness and compliance claims operations based on regular evaluation results
- Able to manage claims operations to ensure compliance with relevant policies and guidelines, as well as regulatory requirements
- Able to identify, adopt, and implement innovative solutions to claims management
- Leadership and communication skills
- Exceptional problem-solving and decision-making skills
- Proficient in Microsoft Office suite and core insurance software
JOB IS EXPIRED.