Our Claims Service Specialist job description includes the responsibilities, duties, skills, education, qualifications, and experience.
About the Claims Service Specialist role
A Claims Service Specialist is responsible for processing, investigating, and resolving insurance claims for customers. This role requires excellent customer service and attention to detail, as well as a thorough understanding of insurance policies, laws, and regulations. The Claims Service Specialist must be able to evaluate and negotiate settlements with clients, and be able to identify and mitigate potential fraud.
Role Purpose
The purpose of a Claims Service Specialist is to provide exceptional customer service to clients and assist in the processing of claims for insurance companies. This role involves interacting with customers to determine the extent of their insurance coverage, as well as providing timely and accurate claims processing services. The Claims Service Specialist is responsible for assessing the validity of claims, updating customer accounts, and adequately informing customers of their coverage options. In addition, they must ensure compliance with all applicable state and federal laws and regulations.
Claims Service Specialist Summary
Claims Service Specialist is responsible for handling and resolving customer inquiries related to insurance claims. They act as the liaison between customers, insurance companies and other third-party vendors. The Claims Service Specialist must have excellent customer service skills, a strong knowledge of the insurance industry, and be proficient in using various computer programs and databases.
This position requires the ability to effectively communicate with customers and other stakeholders, investigate claims thoroughly and accurately, and ensure that all parties involved are kept up-to-date on the progress and resolution of claims. The Claims Service Specialist must be able to make sound decisions quickly and remain calm under pressure.
Claims Service Specialist Duties
- Process and manage customer claims inquiries and requests
- Research customer claims and investigate customer inquiries
- Resolve customer complaints in timely manner
- Provide advice and guidance to customers on claims process
- Handle customer inquiries in person, over the telephone and by email
- Maintain customer records in customer relationship management (CRM) software
- Collaborate with other departments to ensure customer satisfaction
Claims Service Specialist Skills
- Excellent customer service skills
- Strong communication skills
- Ability to handle high stress situations
- Organizational skills
- Attention to detail
- Ability to work independently
Claims Service Specialist Requirements
- Excellent customer service and communication skills
- Knowledge of the insurance industry
- Ability to prioritize multiple tasks
- Ability to work independently and as part of a team
- Proficiency in Microsoft Office applications
Personal Traits
- Excellent communication and customer service skills
- Ability to multi-task
- Strong problem-solving and organizational skills
- Attention to detail
- Ability to work independently and in teams