Claims Officer - #1100863

Job Description

• Follow Standard Operating Procedures (SOP) to screen claims submitted and other parties for admissibility.

• Review and evaluate documentation, flag incomplete submissions, and ensure adherence to policy and regulatory requirements.

• Handle and assess appeals related to claims, coordinating with senior claims officers where necessary.

• Follow SOP to review insurance policies on cases escalated to the Screening Team.

• Ensure valid insurance policies submitted are valid.

• Proactively follow up and communicate with internal departments for policy approval and documentation fulfillment.

• Perform routine administration: recordkeeping, scheduling, document scanning, email/phone communication, data entry.

• Maintain electronic and physical files, ensure accurate record-keeping and audit readiness.

• Coordinate with internal teams and external parties to resolve information gaps swiftly.

• Ensure compliance with company policies and relevant laws.

• Prepare periodic reports on screening outcomes, outstanding appeals, and policy review status.

• Identify irregularities or fraudulent patterns and escalate per SOP protocols.

Requirements

• Diploma/degree in Business Admin, Insurance, Finance, or related field (or equivalent experience).

• 1–2 years experience in insurance, compensation, or claims processing would be a plus.

• Strong working knowledge of SOPs, claims documentation, and compliance procedures.

• Proficiency in MS Office (Excel, Word, Outlook) and claims database systems.

• Excellent attention to detail, data accuracy, and organizational skills.

• High level of integrity and discretion in handling sensitive claims information.