Insurance Claims & Customer Experience Specialist

Manatal; Parañaque; On-site; PHP 391,000 - 614,000; Full time

Job summary

Cover Genius is seeking a Customer Specialist to drive excellent customer experience by ensuring timely handling of tickets and claims through our XClaim platform. You will organize the customer inbox, review and assess claims, and collaborate with Support and Claims teams to meet SLAs and achieve high NPS.

Ideal candidates have 1–2 years of online customer service experience, strong English fluency, and attention to detail.

Qualifications

• 1–2 years' experience handling customer queries online.
• Fluency in English (verbal and written).
• Ability to handle customer inquiries across multiple channels.
• Excellent verbal and written communication skills.
• Proven ability to identify problems and raise them for a solution.
• Experience or interest in claims, insurance, administration, or customer service.
• Strong attention to detail and accuracy when reviewing information, documents, and claims.
• Ability to follow policies, procedures, and guidelines when handling claims and customer requests.
• Strong organisation and time management skills, with the ability to manage multiple tasks and meet deadlines.
• Ability to work collaboratively with Team Leads and colleagues while maintaining a high standard of customer service.

Responsibilities

• Manage the end-to-end claims process, from initial assessment through approval, resolution, and payment.
• Assess claims against policy terms, insurance guidelines, and regulatory requirements to ensure fair and accurate decisions.
• Maintain complete and accurate claim records, documentation, and supporting evidence.
• Communicate with customers clearly and empathetically, providing timely updates and resolving queries throughout the claims process.
• Identify potential fraud or irregularities and elevate suspicious claims for further investigation.
• Collaborate with the Team Lead to resolve complex claims and ensure appropriate outcomes.
• Meet key KPIs, including turnaround time, accuracy, productivity, and customer satisfaction, while maintaining required performance standards.
• Identify and recommend process improvements to increase efficiency, reduce errors, and enhance the customer experience, and communicate recommendations to the Team Lead.
• Support team development by collaborating with fellow assessors, sharing knowledge, and promoting best practices.
• Own the resolution of customers' and partners' inquiries throughout multiple channels.
• Create an ongoing collaboration with the Team Lead to identify improvements to existing customer service processes
• Lead the implementation of new processes to achieve individual and team's KPI's
• Own the quality of our work, including presentation, accuracy, and detail of each particular case, by meeting and exceeding the business KPIs
• Own the triage of tickets into the corresponding inboxes in the different systems (Zendesk, XClaim, other)
• Redirect claims/complaints/support tickets to the dedicated inboxes and team for resolution
• Lead the categorization of the ticket with specific information when required
• Organize the upload of documents and any customer information into the different systems
• Manage translation of tickets via Google translator
• Own admin tasks on partner sites as per the needs (ie. invoice upload)

Skills

Customer service

Verbal communication

Written communication

Attention to detail

Time management

Multi-channel support

Claims experience

Problem solving

Team collaboration

English fluency

Job description

Cover Genius is seeking a Customer Specialist to drive excellent customer experience by ensuring timely handling of tickets and claims through our XClaim platform. You will organize the customer inbox, review and assess claims, and collaborate with Support and Claims teams to meet SLAs and achieve high NPS.

Ideal candidates have 1–2 years of online customer service experience, strong English fluency, and attention to detail.