SKILLS, KNOWLEDGE & COMPETENCIES

• Analytical mindset with a keen eye for detail and risk.
  
• Excellent communication and interpersonal skills.
  
• Strong organizational and time-management abilities.
  
• Strong claims processing acumen and policy interpretation skills.
  
• High level of integrity, discretion, and professionalism.
  
• Ability to handle sensitive and confidential information.
  

3. QUALIFICATIONS & EXPERIENCE

• Bachelor’s degree in Insurance, Actuarial Science, Business Administration, or a related field
  
• Progress towards certification in insurance (e.g., AIIK, ACII, or equivalent).
  
• Minimum of 3 years of experience in insurance claims processing.
  
• Strong knowledge of general insurance products and claim processing lifecycle.
  
• Familiarity with regulatory requirements and fraud detection techniques.
  

• Review and evaluate insurance claims for accuracy, completeness, and compliance with policy guidelines.
  
• Investigate claim details, including gathering supporting documentation and consulting with claimants, service providers, or third parties as needed.
  
• Determine the validity of claims and make recommendations for payment, denial, or further investigation.
  
• Calculate appropriate benefit amounts or reimbursements in accordance with policy terms and coverage.
  
• Communicate with policyholders or other parties to clarify information or resolve discrepancies.
  
• Document all claim decisions and correspondence in the claims management system.
  
• Monitor and manage claims through resolution, ensuring timely processing and follow-ups.
  
• Collaborate with other departments such as underwriting, legal, or customer service when necessary.
  
• Identify trends or irregularities in claims data that may indicate fraud or require escalation.
  
• Ensure compliance with regulatory requirements, industry standards, and internal policies.