Claims Specialist Job Description

claims specialist job description includes a detailed overview of the key requirements, duties, responsibilities, and skills for this role.

Last update : July 14, 2023

Claims Specialist Job Description

A claims specialist is an individual who acts on behalf of an insurance company and is responsible for investigating and settling customer claims.

Claims specialists are employed by the claims department of an insurance company.

Their responsibilities include Verifying the details of a claim.

Determining if the claim warrants further attentionNegotiating with the policyholder to achieve an equitable settlementProcessing the claim for paymentEnsuring that the policyholder is satisfied with the handling of the claimClaims specialists must be comfortable with math, figures, statistics, and communicating with policyholders.

Job Brief:

We’re looking for a Claims Specialist who is detail-oriented and has experience working with insurance claims. The Claims Specialist will be responsible for reviewing insurance claims and ensuring that they are accurate and complete. The Claims Specialist will also work with insurance companies to resolve any claims that are disputed.

Claims Specialist Duties:

  • Track, analyze, and report on claims
  • Review, analyze, and resolve claim issues
  • Maintain accurate records on claims
  • Identify and implement new claims procedures
  • Review and approve new claims
  • Identify, evaluate, and resolve claims in accordance with company standards
  • Monitor the status of claims and follow up on unresolved claims
  • Provide guidance to claims staff regarding claim procedures and policies

Claims Specialist Responsibilities:

  • Maintain claims-submission details to ensure quick and accurate processing
  • Handle incoming claim inquiries and escalated claims
  • Track claim progress, and monitor status of denied claims and appeals
  • Oversee administrative functions, including expense report processing, travel authorization, and benefits
  • Maintain accurate databases for claims submissions and tracking, providing timely reports to management
  • Maintain claims records, including claim history, related correspondence, and claim documents
  • Perform other related tasks

Requirements And Skills:

  • 2+ years experience in insurance or claims, preferably in property & casualty claims
  • Excellent communication, organization, and problem-solving skills
  • Proven ability to analyze claims situations, determine cause, and recommend resolution
  • Highly proficient in the use of Microsoft Word and Excel

At [Company Name], we are an Equal Opportunity Employer that is committed to building a diverse and inclusive team. We encourage applications from all walks of life, including different races, religions, national origins, genders, , and ages. We also value veterans and individuals with different backgrounds and experiences.

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