Assistant Claims Manager
Reports to: Claims Manager
Department: Claims
Job Summary
The Assistant Claims Manager supports the Claims Manager in overseeing the daily operations of the Claims Department. The role involves supervising claims professionals, ensuring efficient and accurate claims processing, maintaining service quality standards, and supporting the development of policies and procedures.
The Assistant Claims Manager helps manage the full claims lifecyclefrom claim notification to settlementwhile handling escalated cases, ensuring regulatory compliance, and driving process improvements to enhance operational efficiency and customer satisfaction. Roles in claims management typically involve supervising teams, reviewing complex claims, and ensuring compliance with insurance policies and regulatory standards.
Key Responsibilities
Claims Operations & Team Management
- Support the Claims Manager in overseeing the day-to-day operations of the claims department.
- Supervise and mentor claims officers, adjusters, and support staff to ensure efficient and accurate claims processing.
- Monitor team performance, workload distribution, and service levels.
Claims Processing Oversight
- Review and evaluate complex, escalated, or high-value claims to ensure timely and accurate processing.
- Ensure claims are assessed in accordance with policy terms, company guidelines, and regulatory requirements.
- Monitor claims turnaround time and service level compliance.
Quality Assurance & Compliance
- Conduct periodic audits and reviews of processed claims to ensure compliance with company policies, legal requirements, and industry standards.
- Identify discrepancies and implement corrective measures where necessary.
- Ensure the claims team remains updated on regulatory changes and internal policies.
Escalation & Dispute Resolution
- Handle escalated claims, disputes, and complex cases.
- Investigate claims issues, negotiate settlements when required, and ensure fair resolutions for all parties involved.
- Work with legal and risk management teams when necessary.
Claims Reporting & Performance Monitoring
- Assist in preparing reports on claims performance, trends, and departmental KPIs.
- Provide insights and recommendations for operational improvements based on claims data and performance metrics.
Process Improvement
- Identify inefficiencies within claims processes and recommend improvements.
- Support the implementation of new workflows, systems, and initiatives to improve productivity, reduce processing times, and enhance customer experience.
Customer Service & Stakeholder Communication
- Ensure clear, timely, and professional communication with clients, policyholders, and claimants regarding claim status and decisions.
- Address client inquiries and concerns throughout the claims lifecycle.
Training & Team Development
- Assist in the onboarding and training of new claims staff.
- Provide ongoing coaching, mentorship, and performance feedback to ensure high standards of professionalism and service.
Cross-Functional Collaboration
- Work closely with departments such as Underwriting, Legal, Customer Service, and Risk Management to ensure smooth claims resolution.
- Coordinate with internal and external stakeholders when necessary.
Claims Decision & Settlement Management
- Review investigation findings and make recommendations regarding claim approval, denial, or settlement.
- Calculate and approve claim payouts within authorized limits.
- Ensure timely disbursement of claim payments.
Required Qualifications
Education
- Bachelor's degree in Business Administration, Insurance, Finance, or a related field preferred.
Experience
- 46 years of experience in insurance claims processing or claims management.
- Prior experience supervising or leading a claims team is an advantage.
Skills & Competencies
- Strong leadership and team management skills.
- Excellent analytical and decision-making abilities in assessing complex claims.
- In-depth knowledge of insurance policies, claims procedures, and regulatory requirements.
- Strong communication and stakeholder management skills.
- Proficiency in claims management systems and Microsoft Office (Excel, Word, etc.).
- Ability to handle escalated claims, disputes, and customer concerns professionally.
Knowledge
- Familiarity with insurance regulations, claims adjudication processes, and compliance requirements.
Preferred / Desired Skills
- Experience handling complex or high-value claims and settlements.
- Strong customer service orientation with the ability to manage sensitive or difficult situations.
- Experience in process improvement and operational efficiency initiatives.
- Ability to work in a fast-paced environment while maintaining attention to detail and meeting deadlines.
- Familiarity with digital claims systems and automation tools.
