Mexico City, MX
Claims Specialist - Claims Adjudicator
About the Role
Are you an early-career Life & Health claims professional looking to grow your technical expertise in insurance and reinsurance?
As a Claims Analyst in Swiss Re’s Life & Health Claims team, you will support the assessment and management of claims, working with experienced colleagues, internal stakeholders, and clients to deliver fair, timely, and well-documented claim outcomes.
This role offers the opportunity to develop claims expertise across Life & Health products, gain exposure to reinsurance, and contribute to a collaborative team focused on client service and customer outcomes.
About the Team
The Life & Health Claims LATAM Team partners with insurers across Latin America to support fair, consistent, and technically sound claims decisions. We combine regional market knowledge, claims expertise, and a client-focused mindset to help improve customer outcomes and portfolio performance.
We work across multiple markets and product lines, collaborating with Underwriting, Medical, Pricing, Client Markets, and Product teams to address complex cases, identify trends, and strengthen claims practices.
Claims are a key moment of truth for customers. In this team, you will support meaningful claims work, learn from experienced professionals, and contribute to solutions that create value for clients and policyholders across the region.
Key Responsibilities
Claims Assessment and Administration
- Assess and manage assigned Life & Health claims within delegated authority and established guidelines.
- Review medical, financial, occupational, and contractual information to support claim decisions.
- Identify missing information, document assessment rationale, and maintain accurate claim records.
- Escalate complex or unusual claims to senior claims professionals when appropriate.
Client and Stakeholder Support
- Build effective relationships with client claims teams and internal stakeholders.
- Participate in claim reviews, client discussions, training activities, and service initiatives.
- Respond to routine claims inquiries with clear, timely, and professional support.
Portfolio Monitoring and Reporting
- Support claims data reviews, trend monitoring, and portfolio analyses.
- Contribute to management reports, audits, quality reviews, and operational improvement activities.
- Help identify opportunities to improve claims processes and service delivery.
Technical Development
- Develop knowledge of Life, Disability, Critical Illness, Health, and Group Insurance products.
- Stay informed on relevant medical, industry, and regulatory developments affecting claims.
- Actively participate in training, coaching, knowledge-sharing, and continuous improvement initiatives.
Collaboration
- Collaborate with Claims, Underwriting, Pricing, Medical, Client Markets, and Operations teams.
- Support cross-functional projects and business initiatives as required.
- Contribute to team goals, knowledge sharing, and a positive working environment.
About You
You are analytical, detail-oriented, and service-minded. You bring sound judgment, curiosity, and a willingness to learn, with the ability to review complex information and collaborate effectively to support balanced claims outcomes.
Required Qualifications and Experience
- Experience in insurance, claims, customer service, underwriting support, healthcare, legal, or a related field.
- Strong analytical, problem-solving, and organizational skills.
- Attention to detail, sound judgment, and effective communication skills.
- Ability to manage multiple priorities in a structured environment.
- Interest in developing technical Life & Health claims assessment capabilities.
- Collaborative mindset and ability to build effective working relationships.
- English intermediate.
Nice to Have
- Exposure to Life & Health insurance products or claims documentation.
- Familiarity with claims systems, workflow tools, data analysis, or reporting.
- Background in insurance, health, legal, nursing, rehabilitation, or business-related studies.
- Progress toward professional insurance designations or industry certifications.
- Portuguese basic level
Success Measures
|
Area |
Expected contribution |
|
Quality |
Accurate, consistent, and well-documented claim assessments. |
|
Service |
Achievement of agreed turnaround times and service standards. |
|
Portfolio management |
Effective organization and management of assigned claim inventory. |
|
Stakeholder support |
Constructive client and internal stakeholder feedback. |
|
Governance |
Compliance with claims procedures, authority limits, and applicable requirements. |
|
Development |
Demonstrated technical learning and application of feedback. |
|
Team contribution |
Active participation in team priorities and improvement initiatives. |
Positioning statement: This is a developing professional role focused on building technical claims expertise, managing assigned work within defined authority, supporting clients and internal stakeholders, and contributing to team delivery. The position is not expected to act as the primary technical authority, own strategic client relationships, or lead the most complex claims independently.
About Swiss Re
Swiss Re is one of the world’s leading providers of reinsurance, insurance and other forms of insurance-based risk transfer, working to make the world more resilient. We anticipate and manage a wide variety of risks, from natural catastrophes and climate change to cybercrime. Combining experience with creative thinking and cutting-edge expertise, we create new opportunities and solutions for our clients. This is possible thanks to the collaboration of more than 15,000 employees across the world.
Our success depends on our ability to build an inclusive culture encouraging fresh perspectives and innovative thinking. We embrace a workplace where everyone has equal opportunities to thrive and develop professionally regardless of their age, gender, race, ethnicity, gender identity and/or expression, sexual orientation, physical or mental ability, skillset, thought or other characteristics. In our inclusive and flexible environment everyone can bring their authentic selves to work and their passion for sustainability.
If you are an experienced professional returning to the workforce after a career break, we encourage you to apply for open positions that match your skills and experience.
We may use AI-powered tools to support the review and evaluation of applications for this position. These tools provide additional insights to our recruitment teams, but all hiring decisions are carefully reviewed and made by people. To learn more about how we use AI in recruitment and how we handle your personal data, please review our Data Privacy Statement before applying.
Reference Code: 139391
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