Senior Claims Specialist

We're Hiring: Senior Claims Specialist

Location: United Arab Emirates (Remote)

Employment Type: Full-Time

Experience Level: Senior

Work Arrangement: Fully Remote

About Us

We are a globally focused insurance organization committed to delivering fair, efficient, and customer-focused claims services across diverse markets. Our teams collaborate across Claims, Underwriting, Risk, Actuarial, Legal, Compliance, Finance, Operations, Customer Service, and external insurance partners to manage claims effectively and support strong policyholder relationships.

Our claims function combines coverage assessment, investigation, loss evaluation, settlement management, fraud prevention, regulatory compliance, and customer service to ensure claims are handled consistently, accurately, and in accordance with policy terms and applicable requirements.

The Role

We are seeking an experienced Senior Claims Specialist to manage complex insurance claims, assess coverage and liability, coordinate investigations, evaluate losses, negotiate settlements, and support claims governance and portfolio performance.

The ideal candidate will combine strong technical claims expertise with excellent analytical, investigative, negotiation, and customer-service capabilities. The role will work closely with policyholders, brokers, insurers, adjusters, underwriters, legal advisors, medical or technical specialists, and internal stakeholders to ensure claims are assessed and resolved efficiently, fairly, and in accordance with applicable policies and regulations.

Key Responsibilities

• Manage complex and high-value insurance claims from initial notification through investigation, assessment, settlement, and closure.
• Review claim notifications for completeness, accuracy, policy applicability, and potential coverage issues.
• Assess policy terms, conditions, exclusions, limits, deductibles, endorsements, warranties, and other coverage provisions.
• Determine whether reported losses fall within the applicable insurance coverage.
• Evaluate liability, causation, loss circumstances, and other factors relevant to claim decisions.
• Conduct detailed reviews of claim documentation, evidence, correspondence, photographs, reports, invoices, estimates, and supporting information.
• Coordinate investigations into complex, disputed, suspicious, or high-severity claims.
• Work with loss adjusters, investigators, surveyors, engineers, medical professionals, legal advisors, and other specialists as required.
• Review investigation reports and determine their impact on coverage, liability, quantum, and settlement decisions.
• Assess the value and financial impact of claims using appropriate methodologies and supporting evidence.
• Review repair estimates, replacement costs, medical expenses, business interruption losses, property damage, liability exposures, and other relevant financial information.
• Establish and review appropriate claim reserves in accordance with internal guidelines and approved methodologies.
• Monitor reserve adequacy and update reserves as new information becomes available.
• Conduct claims analysis and identify material changes in expected claim costs.
• Negotiate claim settlements with policyholders, claimants, brokers, service providers, and other relevant parties.
• Develop settlement recommendations that are consistent with policy terms, evidence, authority levels, and applicable requirements.
• Escalate complex, disputed, high-value, or potentially material claims to appropriate management or specialist teams.
• Manage claims involving multiple parties, insurers, policies, jurisdictions, or areas of liability where applicable.
• Coordinate with Legal teams on coverage disputes, litigation, liability issues, settlement agreements, and legal proceedings.
• Support subrogation and recovery opportunities and coordinate with relevant internal or external specialists.
• Identify potential contribution, recovery, salvage, indemnity, or third-party recovery opportunities.
• Coordinate claims payments and ensure settlements are processed accurately and within approved authority.
• Verify payment calculations, settlement documentation, bank details, and required approvals before payment.
• Maintain accurate and comprehensive claim files throughout the claims lifecycle.
• Ensure claims records, correspondence, investigation reports, settlement documentation, and financial information are accurately maintained.
• Update claims-management systems with accurate status, reserve, payment, coverage, and settlement information.
• Monitor outstanding claims and proactively manage activities required to achieve timely resolution.
• Establish appropriate action plans for complex or delayed claims.
• Monitor claims turnaround times and identify factors contributing to delays.
• Communicate regularly with policyholders, claimants, brokers, and other stakeholders regarding claim progress and requirements.
• Provide clear explanations of claim decisions, documentation requirements, settlement positions, and next steps.
• Handle customer complaints, disputes, and escalations professionally and in accordance with established procedures.
• Support fair and consistent claims outcomes while maintaining appropriate controls and policy standards.
• Identify potential fraud, misrepresentation, exaggeration, staged losses, suspicious documentation, or other claims irregularities.
• Refer suspicious claims to appropriate fraud, investigation, compliance, or legal teams.
• Support fraud-prevention initiatives and claims-integrity controls.
• Analyze claims trends, causes of loss, severity, frequency, settlement patterns, and emerging risks.
• Identify recurring loss drivers and provide insights to Underwriting and Risk teams.
• Work with Underwriting teams to provide claims experience and portfolio feedback.
• Support actuarial analysis by providing accurate claims data, development information, reserve information, and loss trends.
• Coordinate with Finance teams on claims payments, reserves, recoveries, reconciliations, and financial reporting.
• Support claims forecasting, budgeting, and portfolio-performance analysis.
• Monitor claims against service-level agreements, regulatory requirements, internal policies, and delegated authority.
• Ensure claims handling complies with applicable insurance laws, regulations, customer-protection requirements, privacy standards, and internal policies.
• Maintain confidentiality when handling personal, medical, financial, commercial, and legally sensitive information.
• Support internal audits, regulatory reviews, claims-quality assessments, and external examinations.
• Track audit findings and implement corrective actions within required timelines.
• Conduct claims file reviews and quality-assurance assessments.
• Identify claims-handling process gaps and recommend corrective or preventive actions.
• Develop and maintain claims procedures, guidelines, checklists, and workflow improvements.
• Support digital claims initiatives, automated workflows, document management, analytics, and claims-technology improvements.

Key Performance Indicators

• Claims notification turnaround time
• Claims assessment turnaround time
• Claims settlement cycle time
• Claims closure rate
• Outstanding claims reduction
• Claims backlog
• Claims reserve accuracy
• Reserve development performance
• Claims payment accuracy
• Claims settlement accuracy
• Claims handling quality
• Coverage assessment accuracy
• Liability assessment accuracy
• Claims documentation completeness
• Claims file quality
• Investigation completion time
• Investigation quality
• High-value claims management
• Claims escalation timeliness
• Settlement authority compliance
• Claims service-level compliance
• Customer satisfaction
• Customer response time
• Complaint resolution effectiveness
• Disputed-claim resolution rate
• Claims recovery rate
• Subrogation recovery
• Salvage recovery
• Fraud identification rate
• Fraud-prevention effectiveness
• Claims leakage reduction
• Loss-ratio performance
• Claims frequency
• Claims severity
• Claims trend identification
• Claims data accuracy
• Claims-system data quality
• Regulatory compliance
• Policy and procedure compliance
• Audit finding resolution
• Corrective-action completion
• Claims reporting accuracy
• Claims reporting timeliness
• Process improvement completion
• Digital claims adoption
• Stakeholder satisfaction
• Junior-team development

Ideal Candidate

The successful candidate should have strong experience in insurance claims, claims management, loss adjusting, insurance operations, underwriting, insurance broking, or related insurance environments , preferably within an insurer, reinsurer, brokerage, financial institution, or regulated insurance organization.

The candidate should demonstrate:

• Proven experience managing complex insurance claims from notification through settlement and closure.
• Strong understanding of insurance policy wording, coverage, exclusions, limits, deductibles, and endorsements.
• Strong knowledge of claims investigation, liability assessment, loss evaluation, and settlement principles.
• Experience managing high-value, complex, disputed, or sensitive claims.
• Strong understanding of claims reserving and reserve-management principles.
• Experience coordinating loss adjusters, investigators, legal advisors, engineers, medical professionals, and other specialists.
• Strong analytical and financial capabilities for evaluating claim quantum and settlement positions.
• Experience negotiating settlements with policyholders, claimants, brokers, insurers, and third parties.
• Strong knowledge of subrogation, recovery, contribution, and salvage processes.
• Experience identifying and escalating potential fraud, misrepresentation, or suspicious claims activity.