Senior Claims Specialist

About the Role

As a Senior Claims Specialist, Vertical on our Customer Team, you will own the assessment and settlement of claims within your own settlement authority. To drive success in this role, you will have strong attention to detail and great organizational and time management skills. With a bachelor’s degree, you will ideally have experience dealing with customers’ litigations online.

As the Senior Claims Specialist, Vertical, you will review and assess customers’ claims through our XClaim platform, for a fast resolution and prompt payment. Regular collaboration with the Support team, as well as the Content and Complaints team, will be key in ensuring that agreed SLAs and NPS are achieved.

• Subject Matter Expert: Offer specialized knowledge and expertise to support colleagues, ensuring best practices and industry standards are met (e.g. Medical or Licenced).
• Claims Processing: Manage day-to-day claims activities for new claims, reopened claims and declined/appealed and escalated claims including claims actions, emails, and payments.
• Own the assessment and approval of new claims within the authority and fraud thresholds.
• Complex Claims Handling: Manage more complex claims that require deeper analysis, including high-value or multi-policy claims. Including claims appeals and escalations.
• Dispute Resolution: Handle disputes or escalations with empathy and professionalism, ensuring customer satisfaction while protecting company interests.
• High-Stakes Claims Management: Handle the most complex and high-value claims, often involving cross-border issues, reinsurance, or litigation.
• TPA & Underwriter Relationship Management: Build and maintain strong relationships with key partners, customers and other stakeholders to resolve claims, ensure the best customer experience and increase collaboration.
• Documentation:
  Ensure all necessary documentation is collected and filed accurately in the system.
• Quality: Maintain the quality of our work ensuring accuracy to meet business, team and individual KPIs. Collaborate with the QA team, acting as their dedicated to ensure the Claims team are inline with most recent assessment rules.
• Collaboration: Own the communication with all relevant stakeholders (Claims, Support) to resolve claims efficiently and ensure the best customer experience.
• Compliance: Be aware of current insurance guidelines, policy updates, and regulations. Follow company guidelines and local regulations to ensure claims are handled fairly and ethically.
• Process Improvement: Identify and recommend process improvements to enhance claims handling efficiency and operations.
• Mentorship/Training: Provide guidance and training to entry-level claims agents.

• Ensure a +65 NPS
• Work with the team to meet the agreed SLAs
• Ensure the team achieves KPIs
• Mentor the team to meet QA benchmark

What you will bring:

• 4-6 years of experience in claims handling, preferably in an insurance firm.
• Fluency in English (verbal & written) is essential for communicating internally and externally. Any other European language will be highly regarded for external communications.
• Expertise in managing complex, high-value claims, including experience with litigation and cross-border claims.
• Deep knowledge of global insurance markets and regulations.
• Bachelor’s or postgraduate degree in a related field or equivalent is desirable.

What you will have:

• Time Management
• Organisation
• Attention to Detail
• Demonstrates resilience
• Learning orientation
• Relationship building skills
• Communication Skills

• Flexible Work Environment – our teams are hybrid. We work from home on Wednesdays and Thursdays and attend the office on Monday, Tuesday and Friday with flexibility around start/finish times.
• Global company, with the opportunity to work from any of our offices for 4 weeks a year.
• Employee Stock Options – we want our people to share in our success, we reward them with ownership for their contribution in creating a world‑class company.
• Work with like‑minded people who are passionate about both the work we’re doing and giving back. Our CG Gives programs enables us to all become philanthropists through our peer recognition and rewards system.
• Social Initiatives – pictures speak a thousand words.

Cover Genius promotes diversity and inclusivity. We don’t tolerate discrimination, demeaning treatment of anyone, or harassment due to race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or any other legally protected status.