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.