Non-Motor Claims Analyst

Fortune General Insurance Corporation; Pasig; On-site; PHP 223,200 - 334,800; Full time

Job summary

A leading insurance company is seeking a Claims Assistant responsible for end-to-end processing of Personal Accident (PA) Claims. The role involves validating documents, evaluating claims, and coordinating with claimants and adjusters to ensure timely and accurate claim resolutions. Candidates should communicate effectively and maintain accurate records. This position is essential for supporting the claims department within the organization.

Responsibilities

• Process end-to-end Personal Accident (PA) Claims.
• Validate and check correctness of documents from claimants.
• Evaluate claims and make recommendations on compensability.
• Maintain accurate records of all PA claims.
• Communicate effectively with adjusters and claimants.

Job description

The Claims Assistant reports to the Claims Officer and Assistant Manager, Non-Motor Claims and is responsible for end-to-end processing of designated Personal Accident (PA) Claims and other related tasks as assigned. This includes validating documents, evaluating Claims, coordinating with the assureds and/or intermediaries, and ensuring timely and accurate claim resolution in compliance with the company standards.

KEY RESULTS AREAS/DUTIES AND RESPONSIBILITIES

I. Claims Processing

• Validate and check correctness of documents received from claimants or intermediaries.
• Encode reported PA claims in Genweb and set up loss reserves.
• Evaluate claims and make recommendations on compensability.
• Assign claims to independent adjusters when necessary.
• Compute probable liability and prepare in-house reports.

II. Compliance, Documentation, and Investigation

• Maintain accurate records of all PA claims and organize / upload relevant documents in the system.
• Ensure adherence to policy coverages and regulatory requirements.
• Develop investigation plans and gather necessary documents and information.
• Prepare reports and updates for management as needed.
• Keep updated with insurance product knowledge.

III. Customer Service and Coordination

• Communicate effectively with adjusters, claimants / insured parties, intermediaries and others to determine liability and coverage.
• Attend to inquiries related to assigned accounts and provide accurate information.
• Provide assistance and clarification on claim-related inquiries.
• Perform other tasks related to Non-Motor Lines or as required by the immediate superior from time to time.