Claims agent

Job Title: Claims Agent

Department: Claims Operations

Location: California

Job Summary

The Claims Agent is responsible for reviewing, processing, and resolving insurance claims in an accurate, timely, and customer-focused manner. The role involves verifying policy coverage, investigating claims, coordinating with internal teams, and ensuring compliance with company policies and regulatory standards.

Key Responsibilities

• Receive, review, and process insurance claims in accordance with company policies
• Verify policy coverage, documentation, and eligibility
• Investigate claims by gathering statements, reports, and supporting evidence
• Communicate with claimants, policyholders, service providers, and internal teams
• Determine claim validity and recommend approval, denial, or adjustment
• Maintain accurate and detailed claim files and system records
• Ensure compliance with legal, regulatory, and company requirements
• Resolve customer inquiries and complaints professionally and efficiently
• Meet productivity, quality, and turnaround time targets

Required Qualifications

• High school diploma or equivalent (Bachelor’s degree preferred)
• 1–3 years of experience in claims processing, insurance, or customer service
• Basic knowledge of insurance policies and claims procedures
• Strong attention to detail and analytical skills
• Good written and verbal communication skills
• Proficiency in MS Office and claims management systems

Preferred Qualifications

• Prior experience in health, motor, property, or life insurance claims
• Claims certification (e.g., AIC, CPCU – optional)
• Experience handling high-volume claims

Skills & Competencies

• Customer service orientation
• Problem-solving and decision-making skills
• Time management and multitasking
• Ability to work independently and in a team
• Confidentiality and ethical judgment

Compensation & Benefits

• Competitive salary
• Health insurance and paid time off
• Performance-based incentives
• Training and career growth opportunities