Senior Claims Assessor
Zurich International Life Ltd
Total years of experience :13 years, 10 Months
Manage and process a portfolio of high value insurance claims which
include Permanent Total Disability, Critical/Terminal Illness, Death,
Hospitalization, Accidental death, Family Income, Dismemberment and
Waiver of Premium.
Primary responsibilities in this role included:
* Investigation of insurance claims to assess acceptance or denial
of payment under an insurance policy.
* Obtain and examine all necessary information and documents
for the purpose of complete claim investigation.
* Liaison with brokerage companies, medical professionals, law
enforcement professionals, external investigators, Trust
companies, witnesses including claimants to confirm validity of
a claim.
* Assist Zurich’s internal departments - Underwriting, Legal,
Compliance, Financial Crime Prevention, Pricing & Propositions
and Customer Service reps to ensure the prompt handling of
claims including change in policy benefits, premiums and to
keep interested parties apprised of the status of a claim
investigation.
* Interaction with customers for documentation and smooth
processing of claims.
* Uncovering fraudulent claims
* Proactively seeking to clarify and resolve claims using the best
method of communication and initiative
* ‘Keeping Customer First’ in everything we do!
* Verifying and accepting documents in line with the AML
involved risk assessment of life insurance applications with an aim to accept or deny insurance cover, based on Zurich’s Underwriting
principals and guidelines.
Primary responsibilities in this role included:
* Screening of life insurance applications with a detailed approach to verify and assess background information of the applicants, studying insurance proposals and calculating the risk for each policy.
* To determine the appropriate levels of insurance coverage for an applicant
* Writing quotes and negotiating terms with brokers and clients on insurance proposals.
* Complete risk assessment of applicants considering factors such as financial standing, current health status, medical history, travel history, existing amount of insurance cover in force on single risk or joint risk basis.
* Communicating with insurance agents/brokers/consultants and medical representatives to support risk assessment of the
applicant
* Approve insurance coverage within authority limits
Initiatives:
* Introducing medical centers to the existing medical network with the objective to better service our clients/customers
* Handled underwriting services including managing contracts with medical providers, negotiating pricing of medical tests and
added services for high-net-worth individuals.
Role included investigating unauthorized use of HP brand in the market or online and conducting monthly audits on sales reports which included total sales of HP products by the sales representatives.
Primary responsibilities in this role included:
* Recognize possible fraudulent activity and sale of products in grey markets
* • Audit of deals set-up by sales representative and the end customers.
• Identifying and reporting of any sale that could involve slippage in company revenue and the discounts applied on the products.
• Quality check and escalation of any grey market issues
Primary responsibilities in this role included:
• Validating reinsurance contracts and conditions agreed between SwissRe and its clients (treaty and facultative)
• Booking and processing of Statement of Accounts (Bordeaux), Premiums (facultative) and Claims
• Reconciliation of re-insurance accounts with that of Swiss Re and timely escalation of outstanding issues if any.
• Support function for the above activities involved liaising with insurance clients with the focus on resolving queries raised by them and follow-up on pending documentation within the service level standards of the company and updating the policy status on the system.
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