Key Roles and Responsibilities

• Assess potential high-value fraudulent claims by evaluating documents and information collected against common indicators of frauds
• Negotiate with retail customers on settlement amounts, terms and recovery actions in accordance with organisation policies and procedures and applicable laws and regulations 
• Communicate all claims decisions in a timely and appropriate manner and ensure that communication during the assessment process is regular, timely, and clearly documented.
• Determine if technical and/or high-value claims should be accepted based on results of claims analysis and reports from service providers 
• Determine settlement amounts for technical and/or high-value insurance claims based on investigation outcomes 
• Interpret policy wordings and conditions to determine the validity of claims and advises the claimant accordingly
• Negotiate with corporate customers on settlement amounts, terms and recovery actions in accordance with organisation policies and procedures and applicable laws and regulations
• Ensure claim matters are handled according to customer service standards and defined customer experience policies
• Review Key Performance Indicators (KPIs) relevant to each stage of the insurance claims process and propose recommendations to increase efficiency
• Identify claim trends to propose product design enhancements
• Determine appropriate modifications to business processes to ensure seamless transition and minimise resistance for claims handling 
• Ensure accuracy of records and adherence to internal controls
• Maintain compliance frameworks, policies, and procedures to reflect changing regulatory requirements and organisational compliance strategies.

Education and Experience

• Degree in Finance, Insurance or related discipline.
• Minimum of 5 years’ experience in the insurance industry with relevant experience in the same capacity.
• Possession of a Professional certification is an added advantage.

Skills and Competencies requirements

• Demonstrates technical claims knowledge and experience
• Able to provide recommendations to improve claims operations
• Able to analyze claims records to evaluate efficiency and effectiveness of claims operations against predefined performance standards
• Able to improve efficiencies, effectiveness and compliance claims operations based on regular evaluation results
• Able to manage claims operations to ensure compliance with relevant policies and guidelines, as well as regulatory requirements
• Ability to identify, adopt, and implement innovative solutions to claims management
• Leadership and communication skills
• Exceptional problem-solving and decision-making skills