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Introduction Of MASCO Structure Of Classification Starting Salary Guidelines
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Sub-Major Group
26
Legal Professionals
Minor Group
261
Legal Professionals
Unit Group
2619
Legal Professionals Not Elsewhere Classified
Minor Unit Group
MASCO Code
2619-10
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Insurance Claims Arbitrator
Insurance Claims Arbitrator adjudicates disputes between claimants and insurers or social security authorities regarding entitlement to benefits or settlement of claims. They conduct hearings, examine case files and evidence, interpret policy terms and relevant legislation, and assess liability or eligibility before issuing impartial and binding decisions. The role ensures that claims and appeals are resolved fairly, consistently, and in accordance with established legal and regulatory frameworks.
Tasks
Evaluate insurance or social security claims and appeals to ensure fairness, accuracy, and compliance with relevant laws.
Conduct investigations, hearings, or interviews to gather facts, evidence, and testimonies.
Review medical, employment, legal, and public records relevant to claims.
Liaise with involved parties to clarify disputes and gather input.
Apply relevant laws, regulations, and policies to assess claims and appeals.
Make impartial decisions to settle claims and disputes.
Prepare written decisions, opinions, or rulings with clear justifications.
Draft, finalise, and issue arbitration decisions or settlement determinations for parties.
Document all findings, decisions, and actions for official records.
Skills
Basic
Active listening and reading comprehension to understand cases accurately.
Attention to detail in reviewing documents and records.
Effective verbal and written communication skills.
Strong analytical and critical thinking skills to evaluate claims and evidence.
Understanding of relevant insurance policies, regulations, and legal terminology.
Specific
Ability to apply legal reasoning and analytical judgement in deciding claims and appeals.
Ability to conduct hearings and interviews to clarify disputes and assess evidence.
Ability to draft clear decision reports and summaries of evidence.
Ability to interpret insurance policies, legal documents, medical records, and employment evidence.
Competency in assessing insurance and social security claims in accordance with relevant laws and policies.
Competency in case file management, administrative processes, and reporting systems.
Competency in maintaining accurate records for audit, review, or legal purposes.
Knowledge in regulatory, legal, and dispute resolution frameworks governing claims.
Proficiency in claims management and documentation software.
Additional Info
QUALIFICATION
Bachelor’s degree or equivalent
Related Courses
Claimable Course
e-Latih Online Course
Madani TVET Course
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