Job Purpose:
The main task of the role is to settle claims, in accordance with the segregation of duties principle. The Claims Adjuster is responsible for processing claims received (settlement), managing a portfolio of claims and maintaining an appropriate service level. He/she denies, settles, or authorizes payments to routine claims based on coverage, appraisal, and verifiable information. Responsibilities also include corresponding with policyholders, brokers and agents and preparing report of findings of an investigation.
Key Responsibilities:
•Complete second level check of compliance with all policy terms and conditions utilizing commercial, risk and collection systems
•Complete claim payment calculation by incorporating exclusions such as policy deductibles
•Validate claim payment and loss settlement packages up to appropriate authority level
•Reject claim up to appropriate authority level, with strong compliance with internal communication process to enhance customer experience
•Strong two-way communication with policyholders / brokers : request, if necessary, additional documents / information, provide updates on the status of the claim (assessed, settled), handle possible appeals (complaints)
•Strong collaboration with Collections on disputed debts, to assess policyholders’ collection efforts and compliancy with obligations under policy, and to answer Collections requests/ authorizations
•Close claims file following closing of Collections file.
•Handle objections to claims through negotiations with policyholders and any other stakeholders
•Resolve claims issues which may have a major impact on claims settlements and business retention
•Develop and maintain good relationships with policy holders and brokers by understanding their business and responding promptly to their questions
•On a rotational basis take responsibility for the Claims Help Desk and in a timely manner respond to all enquiries received
•Review payment plan submissions and approve up to appropriate authority level
•Review claim filing extensions up to appropriate authority level
Key Exeperience:
Market knowledge:
- Knowledge of Claims and Collections processes and systems
- Knowledge of Quality Standards , C&C operational guidelines
- Ability to identify mandatory documents per type of claims / collection
Business expertise
- Bachelor’s Degree in Business Administration or a relevant field.
- 2-3 years experience in claims settlement with insurance company
Required Skills:
- Excellent communication skills in English, both spoken and written
- Strong interpersonal and communication skills.
- Comfortable with numbers; strong analytical skills.
- Strong attention to detail.
- Ability to determine the appropriate course of action in settling claims
- Result oriented & Team player
- Customer centric
Key Requirements:
-Bachelor’s Degree in Business Administration or a relevant field.
-2-3 years experience in claims assessment with insurance company
-Excellent communication skills in English, both spoken and written
-Basic awareness of Artificial Intelligence technologies and are enthusiastic about learning and integrating AI into everyday business processes.
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- (Generative) Artificial Intelligence or GenAI or AIData Analysis(Microsoft) CopilotChatGPT
- Data Analysis
- (Microsoft) Copilot
- ChatGPT
Key Skills:
- Business expertise
- Basic knowledge of policies, contract law and local insolvency
- Basic knowledge of claims settlement processes and systems
- Understanding of collections process
- Knowledge of quality standards and claims and collection operational guidelines
