Claims Representativ Operations

Job Description

Claims Representative Operations in Romania: Learn about hourly salary ranges for this crucial role.Organizing the complex procedures involved in the assessment, negotiation, and settlement of insurance claims, a claims representative operations plays a crucial role in insurance companies. As the main point of contact for policyholders, agents, and internal stakeholders, these experts are at the forefront of customer service and provide help, direction, and resolution all throughout the claims process.

From the careful receipt and filing of incoming claims to the full range of claims management duties, they are everywhere. Claims Representatives thoroughly investigate each claim to determine its validity and merits. They do this by drawing on their extensive knowledge of insurance laws and regulations as well as their sharp eye for detail. This means combing through minute details, analyzing supporting documentation, and working with several parties to get relevant data required for a just and correct claim.

As Claims Representative Operations the main point of contact for claimants, they answer questions, direct them through the procedure, and keep them informed about the progress of their claims. Claims Representative Operations may also work in tandem with internal departments including actuaries, legal counsel, and underwriters to assess complicated claims and efficiently manage risks. Claims Representatives must negotiate complex regulations and processes while showing empathy for claimants who may be going through terrible situations.

These qualities are strong analytical abilities, attention to detail, and empathy—are essential for this position. Claims Representative Operations play a vital part in preserving the organization’s trust and image by sustaining the highest standards of professionalism and honesty. They also ensure that claims are resolved fairly and promptly.

Brief Job Description

The mission of this job is to promptly analyze policy files to determine and pay correct policy death benefits and beneficiaries and to handle incoming calls related to the death benefits.

Claims Representative Operations Responsibilities

• Accountable for identifying, investigating, evaluating, obtaining and utilizing critical information required to accurately and objectively adjudicate claims.
• Verbally communicate and correspond with outside customers to convey claim filing requirements.
• Handles claim inquiries and processing on multiple product lines.
• Documents all calls clearly and concisely and completes follow-up work.
• Identify areas of potential risk for the company, including potential fraud.
• Analyze all incoming documents for appropriateness and completeness, and determine whether claim is payable. If so, calculate benefit amounts and serve as 1st approver for payments.
• Serves as the first step in resolving claims adjudication issues and in the call escalation process.
• May be responsible for incoming and outgoing calls to claimants, Power’s of Attorney, facilities and other person’s or entities involved in the adjudication of a claim.
• Ensure all tax information is correctly reported.
• Maintain claim file with proper level of documentation.
• Answer customer inquiries.
• Maintain claim inventories within departmental, contractual, and regulatory guidelines.

Basic Qualifications

• Death claims processing for life and/or annuity contracts preferred
• Two-year college degree or equivalent experience in a financial institution operations department, customer service, or annuity product experience.
• Knowledgeable in life or annuity products and death claim processing
• Must have sharp attention to detail and ability to perform with high degree of accuracy.
• Strong analytical skills to review documents and reach sound decisions
• Proven oral and written communication skill set.
• Ability to:
• Meet multiple performance targets at or above benchmark levels; including, but not limited to: accuracy, call quality, timeliness, and productivity.
• Work harmoniously with peers within a small team environment to accomplish both personal and team performance goals.
• Work with customers in a professional and empathic manner
• Work overtime, as needed, to meet daily deadlines
• Work simultaneously with multiple computer systems
• Compute moderately difficult mathematical calculations
• Available for 8 hour shift between 8am to 8pm working hours; Work from home.

• Inventory Coordinator