Claims Officer

Job Summary:

The Claims Officer II is responsible for managing and processing claims efficiently while ensuring compliance with organizational policies, procedures, and service standards. The role involves reviewing claim documents, verifying claim validity, conducting investigations where necessary, coordinating with stakeholders, and ensuring timely settlement of approved claims. The position contributes to maintaining operational accuracy, minimizing risk exposure, and improving customer satisfaction through effective claims administration.

Educational Qualification:

• BA/BSc Degree in Management, Statistics, Engineering, Economics, Marketing, or related fields from a recognized University.

Experience Required:

• Minimum of 3 years of relevant work experience.
• At least 1 year of experience in the position of Claims Officer I or an equivalent role.

Key Responsibilities:

• Receive, review, and process claims in accordance with company policies and operational procedures.
• Verify claim documents for completeness, accuracy, and eligibility before processing.
• Conduct preliminary claim assessments and investigations where necessary.
• Analyze supporting documents and determine claim validity and settlement recommendations.
• Coordinate with internal departments, clients, service providers, and external stakeholders during claim handling processes.
• Ensure timely claim settlement while maintaining service quality standards.
• Prepare claim reports, summaries, and performance analyses for management review.
• Maintain complete and accurate claim records and documentation.
• Identify suspicious, fraudulent, or irregular claims and escalate findings appropriately.
• Monitor claims trends and provide recommendations for process improvement and risk reduction.
• Support customer inquiries and provide professional guidance regarding claims procedures.
• Ensure compliance with regulatory requirements and organizational policies.

Required Skills & Competencies:

• Strong analytical and problem-solving skills.
• Excellent attention to detail and accuracy.
• Knowledge of claims administration and evaluation processes.
• Strong report writing and documentation skills.
• Good communication and stakeholder management abilities.
• Ability to make objective and timely decisions.
• Proficiency in Microsoft Office applications and claims management systems.
• Strong organizational and time management skills.
• High integrity, confidentiality, and professional ethics.

Skills Required:

• Accounting / Finance
• Economics / Statistics
• Sales / Marketing / Business / Management