Claims Manager

Function Purpose The Claims Function in our insurance broking company is designed to facilitate the efficient and accurate processing of insurance claims. This function aims to ensure timely resolution of claims, maintain client satisfaction, and uphold the credibility of the organization by adhering to ethical and legal standards.

Role Purpose

The purpose of the Claims Role is to effectively manage the claims process for clients, ensuring a smooth and fair settlement of claims. The role involves reviewing and validating claims, liaising with insurers, advocating for clients' interests, and guiding them through the claims process to achieve a satisfactory outcome.

Key Expectations of the Role

Claims Processing and Documentation :

Accurately review and process claims in adherence to established protocols and guidelines.

Ensure all necessary documentation is collected and maintained for each claim, including client statements, accident reports, and relevant records.

Client Advocacy and Communication :

Act as the main point of contact for clients during the claims process, providing timely updates and information.

Advocate for clients' interests and rights, ensuring a fair and just settlement of claims.

Settlement or Compromised Settlement :

Engage in substantiating the claim to the insurers to secure optimal claim settlements for clients.

Ensure that settlements are fair and appropriate, considering policy terms, legal requirements, and clients' expectations.

Conflict Resolution and Customer Service :

Address client concerns, disputes, and inquiries related to claims in a professional and timely manner.

Facilitate conflict resolution and maintain positive client relationships throughout the claims process.

Competencies Required for the Role

Insurance Knowledge :

Possesses a strong understanding of insurance policies, coverages, and claims processing.

Familiarity with insurance regulations, industry standards, and claims-related legal aspects.

Communication and Interpersonal Skills :

Demonstrates clear and effective communication, both written and verbal, to convey complex information to clients and internal stakeholders.

Exhibits strong interpersonal skills to manage client interactions with empathy and professionalism.

Analytical Thinking and Problem-Solving :

Utilizes analytical skills to assess claim details, policy information, and relevant documents to make informed decisions.

Identifies potential challenges and develops effective solutions to ensure smooth claims processing.

Negotiation and Persuasion :

Demonstrates effective negotiation skills to achieve optimal claim settlements for clients.

Persuasively presents clients' cases and arguments to insurers, supporting claims in the best interest of clients.

Interpersonal Skills : Strong interpersonal skills, including the ability to empathize with clients, manage client expectations, and effectively communicate during the claims process.

Personal Qualifications

Educational Background : A bachelor's degree in business, insurance, finance, or a related field is preferred.

Experience : Prior experience in claims processing, claims handling, or related roles within the insurance industry is advantageous.

Certifications : Relevant certifications in claims management or insurance claims are beneficial.

Technology Proficiency : Proficient in using claims management systems, CRM software, and Microsoft Office suite (Word, Excel, Outlook, etc.).