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Job Summary: Manage and process insurance and non-insurance benefit claims, ensuring their effective resolution and compliance with service and quality standards for customers and insured parties. Key Responsibilities: 1. Management and processing of benefit claims. 2. Ensuring service quality for customers and insured parties. 3. Detection and management of potential fraud. **Contract Type** -------------------- **Description** --------------- Perform claim management and processing activities across various coverages, guarantees, and services within the assigned business line, arising from insurance or non-insurance contracts, in accordance with applicable regulations, contractual conditions, technical standards, and instructions from supervisors, to ensure timely and cost-effective resolution of claims while meeting service and quality objectives for customers and insured parties. **Responsibilities** ------------- * Maintain up-to-date, innovative, specific, and/or specialized knowledge of procedures, regulations, technical criteria, etc., within one's scope of work, through participation in training sessions and monitoring of key performance and quality indicators. * Process assigned benefit or service claims at one's level, in accordance with unit guidelines and procedures, ensuring high-quality service to insured parties to minimize complaints and claims. * Analyze incoming documentation to determine coverage for each claim based on the affected contractual conditions and the policyholder’s agreement, conduct initial valuation, inform insured parties, and request additional information or documentation as needed for proper claim handling. * Conduct daily review of departmental incoming documentation (customer letters, letters from opposing insurers, expert reports from opposing insurers, settlement documents, expert opinions), and respond to calls from customers, agents, experts, and claimants to provide service and information regarding claims within one's scope, facilitating claim resolution while maintaining service quality. * Assign damage assessment/responsibility valuation tasks to the appropriate professional/expert and review resulting reports; where necessary, verify their suitability, to ensure optimal and efficient technical support for claim resolution and detection of potential fraud for specific handling. * Manage payment of workshop and customer invoices at one's level; if applicable, pursue payments from debtor entities and/or propose settlements to insured parties, lawyers, and insurers; and, where appropriate, execute corresponding disbursements, to ensure claim resolution under optimal time and cost conditions for the unit or Group, within one's area of responsibility. **Education** ------------- **Experience** --------------- **Competencies** ---------------- Insurance Sector Knowledge of insurance operations Fraud management in insurance Claims knowledge Customer relationship management Supplier management Customer service policies, standards, and procedures Claims management Analysis of loss ratios**Application Deadline** -------------------------------
