Job Purpose: The main tasks of the role is to define company’s liability (assessment) according to contractual provisions. The Senior Claims Adjuster is responsible for processing claims received and allocation of recoveries, managing a portfolio of claims and maintaining an appropriate service level per segment which supports customer satisfaction objectives. He/she analyzes and reviews claims for accuracy, completeness and eligibility, and prepares and maintains reports and records for processing.

Key Responsibilities:

Assess claim submission by checking compliance with all policy terms and conditions utilizing commercial, risk and collection systems
Complete coverage analysis to determine liability to the company
Validate claim assessment and set financial reserve up to authority level of $270,000
Reject claim up to personal authority level of $270,000, with strong compliance with internal communication process to enhance customer experience
Strong two-way communication with policyholders / brokers: request, if necessary, additional documents / information, provide updates on the status of the claim (assessed, settled), handle possible appeals (complaints)
In case of non-inclusive collection, liaise with Collections to assess policyholders’ collection efforts and compliancy with obligations under policy
Answer Collections requests/ authorizations
Strictly enforce the policy wording and reach out to MMCD for commercial considerations
Process commercial gestures approved by Commercial department and liaise with Commercial in case of contractual question
Develop and maintain good relationships with policy holders and brokers by understanding their business and responding promptly to their questions
On a rotational basis take responsibility for the Claims Help Desk and in a timely manner respond to all enquiries received
Review payment plan submissions and approve up to authority level of $250,000 and 6 months
Review claim filing extensions up to authority level of $250,000 and 6 months

Key Experience:

Knowledge of Claims and Collections processes and systems
Knowledge of Quality Standards, C&C operational guidelines
Ability to identify mandatory documents per type of claims / collection
Bachelor’s Degree in Business Administration or a relevant field.
5-10 years’ experience in claims assessment with insurance company
Excellent communication skills in English, both spoken and written
Strong interpersonal and communication skills.

Key Skills:

Excellent knowledge of policies, contract law and local insolvency
Excellent knowledge of claims settlement processes and systems
Excellent knowledge of collections process
Excellent knowledge of quality standards and claims and collection operational guidelines

Allianz Trade in North America

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Senior Claims Adjuster