Job Details
Claims Investigation Officer required by a leading global insurance company specialising in technology.
This is a full time PERMANENT ROLE – working full time hours (40 hours per week – shift patterns in operation)
Salary £30k per annum plus excellent benefits – 100% REMOTE / HOME WORKING – postholder can be based anywhere in the UK
Key aspects of the role:
- Assess claims efficiently and fairly to ensure that legitimate claims covered by the policy are processed with minimum delay
- Ensure that any escalated claims denied because they are not covered by the policy, are done so fairly in accordance with the agreed business rules
- Contribute to fraud reduction by denying claims which, through an objective assessment of the evidence, are a reasonable indication of fraud according to the agreed business rules.
- Ensure that in the event of a denial that all evidence is clearly recorded, and the customer understands the reasons for the denial.
- Ensure that customers are always treated fairly and in accordance with the core values of the company.
- Ensure that the business responds to claims as the customer would reasonably expect of the policy.
- Assess claims that have been escalated for adjudication, against agreed business rules and using a range of tools.
- Record evidence and decision making, within the tools provided, which supports an adjudication decision.
- Update customer records promptly to ensure that staff who have contact with customers have all the right information to be able to inform to the customer accurately and take appropriate action.
- Hold investigation conversations with customers to clarify information as necessary prior to approving or denying a claim.
- Contact customers primarily by telephone, but also by email and letter, to communicate a denial and give clear reasons.
- Complete claim completion processes in some cases where an approval to proceed is the outcome.
- Contribute to the ongoing development of the adjudication process through proactive feedback.
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