About the Role

Our client, WhatJobs Direct , is seeking a compassionate and detail-oriented Especialista en Reclamaciones de Vida y Gastos Médicos Mayores to join their dedicated team in Tuxtla Gutiérrez . This critical, in-office role involves managing the sensitive and complex process of life insurance and major medical expense claims. You will be the primary point of contact for policyholders and beneficiaries during challenging times, ensuring a smooth, respectful, and efficient claims resolution. The idóneo candidate has a strong understanding of life and health insurance policies, excellent communication skills, and a commitment to providing exceptional service with empathy and professionalism. This position requires a high level of integrity and meticulous attention to detail to ensure accurate claim processing and compliance.

Key Responsibilities

- Process and manage claims related to life insurance policies and major medical expenses from initiation to closure.
- Review claim forms, supporting documentation (medical reports, death certificates, etc.), and policy provisions to determine coverage eligibility.
- Communicate empathetically and clearly with claimants, beneficiaries, and healthcare providers regarding claim status, requirements, and decisions.
- Investigate claim details, verify information, and ensure compliance with all policy terms and regulatory requirements.
- Calculate and authorize claim payments accurately and in a timely manner.
- Maintain detailed and organized claim files,



documenting all actions, communications, and decisions.
- Collaborate with underwriting, medical review teams, and legal counsel when necessary to resolve complex claims.
- Identify potential fraud or abuse and report as per company procedures.
- Adhere to service level agreements and key performance indicators for claims processing.

Requirements

- Minimum of 3 years of experience in processing life insurance and/or major medical claims.
- Thorough understanding of life and health insurance principles, policy contracts, and medical terminology.
- Exceptional communication, interpersonal, and customer service skills, with a high degree of empathy.
- Strong analytical and problem-solving abilities with meticulous attention to detail.
- Proficiency in claims management software and standard office productivity tools.
- Ability to work effectively in a team environment and manage a demanding workload in an office setting.
- High school diploma required; an associate's or bachelor's degree in a related field is a plus.
- Knowledge of relevant insurance laws and regulations in Mexico.

Benefits

- Competitive salary and benefits package.
- Opportunity to work in a meaningful role making a difference in people's lives.
- Professional development and training programs.
- Stable work environment in Tuxtla Gutiérrez .
- Paid time off and holidays.
- Contribution to retirement savings plans.
- Supportive team culture and management.

📌 Especialista en Reclamaciones de Vida y Gastos Médicos Mayores (Tuxtla Gutiérrez)
🏢 Placements24
📍 Tuxtla Gutiérrez