Specialist - Claims

Position Summary:

The Claims Specialist is responsible for managing claims assessment and driving the closure of insurance claims as per policy and regulations. The role performs claims assessment, determines coverage, evaluates damages, and negotiates settlements with claimants or their representatives. They collaborate closely with clients, adjusters, and legal teams to ensure fair and timely resolution of claims while adhering to company policies and industry regulations.

Location:

Mumbai - India

What will your job entail?

Job Responsibilities:
• Reviews incoming insurance claims to ensure they are complete by examining documentation such as accident reports, medical records, and policy information.
• Determines the extent of coverage provided by the insurance policy, compares the details of the claim with the terms and conditions to determine claim eligibility and payment.
• Utilizes knowledge and experience in insurance to assess, investigate, and evaluate claims. Ensures compliance with company policies, local regulations, and industry standards while handling and processing claims.
• Facilitates seamless claim processing and resolution, investigates the circumstances surrounding a claim to determine its validity by interviewing associated stakeholders and inspecting sites or reviewing technical documentation etc.
• Calculates the amount of compensation or benefits the claimant is entitled to receive based on factors such as deductibles, policy limits, depreciation, and applicable laws or regulations.
• Engages in negotiation with claimants or their representatives to reach a fair settlement in cases where there are disputes or disagreements regarding the claim.
• Communicates with various stakeholders involved in the claims process, including claimants, policyholders, insurance agents, medical professionals, and legal representatives.
• Maintains detailed records of all claim-related activities, including correspondence, investigation findings, payment calculations, and settlement agreements.
• Participates in training and professional development activities to stay informed about industry trends and enhance their skills.

Work Experience and Education:
Minimum of 5 years of experience in Claims processing, adjusting/examination, investigation with a Bachelor’s degree, or 3 years and a Master’s degree.
Bachelor’s degree required, Master’s degree preferred; Business Administration, Finance, Legal is preferred. Any other related discipline or commensurate work experience considered.
Licenses & Certifications:
• Prescribed: Minimum requirements for state specific Adjusting/Appraising/Examining/ Investigating Licenses
• Preferred: Associate in Claims (AIC), Certified Insurance Service Representative (CISR), Certified Claims Professional (CCP), Certified Insurance Claims Manager (CICM)

Disclaimer

Ryan Specialty is an Equal Opportunity Employer. We are committed to building and sustaining a diverse workforce throughout the organization. Our vision is an inclusive and equitable workplace where all employees are valued for and evaluated on their performance and contributions. Differences in race, creed, color, religious beliefs, physical or mental capabilities, gender identity or expression, sexual orientation, and many other characteristics bring together varied perspectives and add value to the service we provide our clients, trading partners, and communities. This policy extends to all aspects of our employment practices, including but not limited to, recruiting, hiring, discipline, firing, promoting, transferring, compensation, benefits, training, leaves of absence, and other terms, conditions, and benefits of employment.