Claims Processor

Cocogen Insurance, Inc.; Pasig; On-site; PHP 300,000 - 420,000; Full time

Benefits offered by this job

Guaranteed 15 months’ pay

HMO

Medical reimbursements

Training opportunities

Company events

Job summary

Cocogen Insurance, Inc. invites you to join our claims team in Pasig. The role focuses on processing, evaluating, and issuing settlement checks while ensuring accuracy and compliance with loss documentation and fraud indicators.

You will coordinate with sub-contractors and the Recovery Section as needed. Responsibilities include on-the-spot evaluations, adjusting loss reserves, and preparing LOA/offer letters.

Qualifications

• Bachelor’s Degree in Business Administration, Marketing or related field.
• Background in handling Non-Life insurance is an advantage.
• Willing to work in Ortigas Center, Pasig City.

Responsibilities

• Processes, evaluates and prepares settlement checks, ensuring fraud indicators are checked and documented.
• Checks completeness and validity of proof of loss documents and monitors adjusters' reports.
• Evaluates compensability, approves settlements within authority or recommends settlements for approval.
• Updates loss reserves, communicates with insured/producers, and prepares LOA or offer letters.
• Coordinates with Recovery Section when needed and maintains organized claim files.
• Conducts on-site inspections when required and handles on-the-spot cash settlements for petty motor claims.
• Ensures settlements are registered in the system and files are properly closed.

Education

Bachelor’s Degree in Business Administration, Marketing or any related field

Job description

Job Description:

Join our roster of exceptional people!

Perks & Benefits:

• Guaranteed 15 months’ pay
• HMO
• Medical reimbursements
• Internal & external trainings
• Year-round fun & exciting Company Events
• Employee appreciation
• Work-life balance

Job Description

1. Processes, evaluates and prepares settlement checks by performing the following:

• Ensures that no red flag indicators (fraud indicators) are noted in the claim being processed, otherwise conduct an investigation and report noted irregularity for appropriate action of superior.
• Checks completeness and validity of proof loss documents.
• Assigns the adjustment of the loss to an accredited sub-contractor; monitors the regularity of the adjusters report and report any noted deviation on the adjusters handling the assignment, and the unreasonable delay in the submission of such for appropriate action.
• Evaluate compensability or deniability based on the proof of loss documents; approves settlement within the authority given, otherwise submit recommendation of settlement for approval. Should the loss be deniable, recommend denial stating the grounds for such recommendations.
• Adjusts / amends Loss Reserve and updates system re: status of claim; ensures zeroing out loss reserve balances for closed / fully settled claim.
• Appraises Insured / Producers with regard to the status / progress of their claim.
• Prepares and releases Letter of Authority (LOA) and/or offer letter to the concerned party; negotiates with the concerned party the approved amount of settlement and monitors its acceptance.
• Ensures reasonability of the billing statement of subcontractors, and prepares payment request for settlement of bills / cash settlement.
• Coordinates / refers the claim file with the Recovery Section if with recovery and ensures proper tagging of the recovery in the system.
• Maintains an efficient and accessible file system for claims being processed, and closes claim file in the system and boxes it accordingly

2. Conducts immediate inspection of the damaged properties, when necessary or required by other Processors and prepares timely recommendation report.

3. In-charge of the on-the-spot cash settlement on petty motor car claims by observing the following.

• Ensures that no red flag indicators (fraud indicators) are noted in the claim being processed, otherwise follow the usual claims processing.
• Ensures regularity of the insurance policy and the completeness and validity of proof of loss documents submitted, and that the cause of loss is compensable.
• Evaluates loss based on actual damage, offers the evaluated amount, if accepted, issues settlement check provided it is within the authority given, otherwise recommends approval and ensures that the corresponding settlement check be approved and released immediately.
• Ensures that all claims settled are registered in the system and the file is complete and filed properly.

Qualifications

• Candidate must possess a Bachelor’s Degree in Business Administration, Marketing or any related field;
• Background in handling Non-Life insurance is an advantage;
• Must be willing to work in Ortigas Center, Pasig City;