FWD Group
Finance / FinServ
SeniorClaimsSpecialist
“Senior Claims Specialist at FWD Group. Skills: Claims assessment, Policy interpretation, Complex claims handling, Regulatory standards adherence, Customer experience delivery. Perform detailed assessment of complex, high-value, or sensitive claims. Manage assigned claim cases to ensure timely progression and adherence to target turnaround times (TATs) and internal service level agreements”
What You'll Achieve.
Accurate, timely, and contract-based assessment of insurance claims; Delivery of a positive customer experience; Objective claim decisions; Adherence to policy provisions; Timely progression of assigned claim cases; Adherence to target turnaround times (TATs); Adherence to internal service level agreements; Uplift claims quality and consistency
Industry & Context.
Assessment of complex, high-value, or sensitive claims; Resolution of escalated cases; Resolution of potential customer complaints; Assessment of exception cases
What They're Looking For.
Must Have
Experience with policy interpretation, Experience with claims standards, Experience with complex claims handling
Nice to Have
Subject-matter expert on policy interpretation, Subject-matter expert on claims standards, Subject-matter expert on complex claims handling
What You'll Do.
Perform detailed assessment of complex
Manage assigned claim cases to ensure timely progression and adherence to target turnaround times (TATs) and internal service level agreements
Recommend claim outcomes and escalate cases requiring higher authority
Support resolution of escalated cases or potential customer complaints
Ensure proper application of non-forfeiture provisions
and policy conditions
Validate claim documentation
and investigative findings
Act as a subject-matter expert on policy interpretation
and complex claims handling
Support onboarding and technical training of new Claims team members
Provide guidance and technical coaching to Claims Ambassadors and Analysts
Participate in or co-lead claims-related projects and initiatives
Assist in the preparation of administrative
and statistical reports
Support User Acceptance Testing (UAT) and implementation of system enhancements
or claims workflow changes
How You'll Work.
Team & Collaboration
Cross-functional collaboration; Escalate cases to Claims Committee, Underwriting, Medical, Legal, or Finance; Provide technical justifications and decision rationale to Claims Ambassadors for customer communication; Provide guidance and technical coaching to Claims Ambassadors and Analysts
Communication Scope
Customer communication; Technical justifications; Decision rationale
Process & Methodology
Process improvements, Risk controls, Efficiency enhancements, Claims-related projects and initiatives
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