Senior Claims Processing Officer – Complex Cases

About the role

The Senior Claims Processing Officer is responsible for reviewing, assessing and processing complex or high‑cost insurance claims. You will ensure decisions are fair, compliant and well documented while supporting the team in meeting performance targets.

Key responsibilities

• Review and assess complex or high‑value claims in line with standard operating procedures.
• Make decisions on difficult cases, ensuring compliance and clear documentation.
• Process approved claims for payment, coordinating with internal departments and third‑party administrators.
• Handle escalated customer queries or complaints, explaining decisions and managing expectations professionally.
• Support the Team Leader with daily activities, mentor junior colleagues and act as backup Team Leader when required.
• Utilise AI, machine‑learning and data‑analytics tools responsibly, adhering to data‑governance and ethical standards.
• Perform additional ad‑hoc tasks to maintain smooth team operations.

Required profile

• 2–3 years of experience in a customer‑focused environment, preferably in clinical, paramedical, TPA or insurance roles.
• Bachelor’s degree in a medical, paramedical, finance, business administration, insurance or related field, or equivalent experience.
• Strong customer focus with excellent communication and interpersonal skills.
• Proven ability to work under pressure, meet tight deadlines and maintain service standards.
• Collaborative, ethical team player who can share knowledge and step in when needed.
• Legal right to work in the country of operation and ability to meet any physical requirements of the role.

Required skills

• Proficient use of MS Office.