个险理赔专员

Role and Context / 职位定位与背景
This role handles basic retail claims of Travel Insurance and Personal Accident Insurance processing under close supervision, including documentation review, system input, communication, and service coordination.
在主管的指导下，负责处理基础至中等复杂度的个人旅游险及个人意外伤害保险理赔案件，包括基础审核、资料管理、系统操作及客户沟通，确保案件准确、高效处理。

Key Tasks & Accountabilities / 主要职责与责任
(I) Claims Assessment
•    Review claim documents submitted by customers to ensure completeness, authenticity, and compliance.
•    Conduct preliminary screening of cases to identify potential fraud risks and escalate suspicious cases.
•    Enter, update, and maintain case information in the system to ensure data accuracy.
•    Close general cases according to authorized approval level.
（一）理赔审核
- 审核客户提交的理赔材料，确保完整性、真实性与合规性。
- 对案件进行初步筛查，识别潜在欺诈风险并上报异常案件。
- 在系统中录入、更新并维护案件信息，确保数据准确无误。
- 根据权限完成一般性案件结案处理。

(II) Customer Communication
•    Proactively contact customers to explain claim requirements, document checklists, and assessment progress.
•    Respond to customer inquiries professionally to enhance the claims experience.
•    Assist in handling basic customer complaints and escalate to supervisors when necessary.
（二）客户沟通 
- 主动与客户联系，说明理赔要求、材料清单及审核进度。
- 以专业态度回应客户咨询，提升理赔体验。
- 协助处理客户投诉的基础问题，并在必要时升级给主管。

(III) Cross-functional Collaboration
•    Maintain effective communication with Customer Service, Finance, New Business, Underwriting, and other departments.
•    Coordinate with external partners (such as hospitals and agency partners) for information verification or communication.
（三）跨部门协作 
- 与客服、财务、新契约、核保等部门保持良好沟通。
- 与外部合作伙伴（如医院、合作代理人等）进行资料核查或沟通。

(IV) Compliance & Process Management
•    Strictly follow company claims procedures, internal control standards, and regulatory requirements.
•    Participate in process optimization, system testing, and support for special departmental projects.
（四）合规与流程管理 / Compliance & Process Management
- 严格遵守公司理赔流程、内控规范与监管要求。
- 参与部门流程优化、系统测试及专项项目支持。

Qualifications & Experience / 任职资格与经验
•    Bachelor’s degree or above.
本科及以上学历。
•    Bachelor’s degree or above in any field; background in insurance, travel, medical, or legal disciplines is an advantage. strong fresh graduates considered.
-本科及以上学历，专业不限（有以下从业经验者优先：保险、旅游、医学、法学）。优秀应届毕业生亦可考虑。
•    Good communication skills and customer service mindset.
具备良好的沟通能力与客户服务意识。
•    Ability to prioritize and manage deadlines.
具备任务优先级管理和按时完成工作的能力。
•    Proficient in office software and claims/data management systems.
熟练使用办公软件及数据系统。
•    Detail‑oriented and responsible, with strong professional ethics.
工作细致、负责，具备良好的职业操守。
•    Fluent in Mandarin and Cantonese; capable of daily English reading and writing.
普通话与粤语流利；能应对日常英文读写沟通。
•    Able to travel occasionally (0–5%); primarily based in Guangzhou office.
可接受少量出差（0–5%），主要在广州办公。