Claims Analyst

6 months ago

Kuala Lumpur, Malaysia Zurich Insurance Full time

Job Summary- With moderate direction, handles single and multi-party personal or commercial line claims of moderate exposure and complexity within specific authority limits, to ensure that claims are handled in the most efficient, effective way while delivering a customer-centric claims service.- Job Accountabilities - Key Accountabilities- Document claims file by accurately capturing and updating claims data/information in compliance with best practices for single and multi-party personal or commercial line claims of moderate complexity and exposure.
- Exercise judgement to determine liability by gathering and analyzing relevant facts; utilizing applicable law; establishing basic principles of negligence.
- Exercise judgment to determine policy verification and coverage determination by analyzing applicable coverage for claims and determining whether the loss falls within the coverage.
- Work to have a timely resolution to claims by developing case strategy; developing a case evaluation; escalating issues as appropriate.
- Establish timely reserves and perform ongoing review throughout claims cycle within authority limit by estimating and validating value of claims.
- Assess damages by calculating applicable damages or range of damages allowed by law.
- Negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits.
- Meet quality standards by following best practices.
- Ensure customer service by proactively communicating information; responding to inquiries; following customer protocols and may participating in customer marketing efforts.
- Manage litigation by assigning counsel within the approved panel where applicable; establishing litigation plan and budget; coordinating defense lawyer activities; continuously reviewing the potential for settlement with claimant; reviewing litigation expenses and authorizing payments.
- Manage expenses by working within vendor approved networks and managing scope of work assigned to outside contractors. Departs from approved vendors with manager approval, where in the best interests of the insured.
- Ensure legal compliance by following state and federal laws and regulations and internal control requirements.
- Refer claim to subrogation and fraud teams by identifying potential subrogation and fraud.
- Contribute to profitable growth by providing risk insight, information and trends to Business Unit or customer as needed.
- Serve as a technical resource by mentoring lower level claims professionals and sharing technical knowledge related to specific Line Of Business expertise.
- Protect Zurich's reputation by keeping claims information confidential.
- Maintain professional and technical knowledge by participating in educational opportunities, staying current with industry trends, establishing personal networks. And participating in professional societies.
- Contribute to the team effort by accomplishing related results and participating on projects as needed.
- Business Accountabilities- Anticipate, recognize and respond timely to inquiries to ensure customer satisfaction.
- Collect data and document in established systems including commentary and an analysis of trends to facilitate decision-making.
- Acquire and organize the relevant evidence and information to accurately assess the value of the claim.
- Analyze data using pre-determined tools, methods and formats and make recommendations in order to support the department’s timely resolution of claims.
- Provide technical advice that enables a customer to solve a problem or improve business.
- Adhere to local regulatory and governance requirements throughout the life of a claim to ensure decisions are made using the right standards.
- Identify and resolve problems by referring to policies, procedures, and standards to ensure consistency and quality of solutions.
- Assess and appoint claims vendors within agreed authority limits aligned to the organization´s Claims Vendor Management strategy.
- Determine when to solicit input from more senior colleagues or managers for more complex issues, to ensure quality and continuous learning.
- Assess and evaluate claims handling processes and systems in order to identify opportunities for improvements.
- Identify training needs and mentor lower level staff to build on the capabilities of the team.
- Job Qualifications- Required:
- Bachelor's degree in finance, business administration, insurance, or a related field.

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