Job Description

Positions General Duties and Tasks:

• Process Insurance Claims timely and qualitatively
• Meet & Exceed Production, Productivity and Quality goals
• Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities
• Analyze customer queries to provide timely response that are detailed and ordered in logical sequencing
• Cognitive Skills include language, basic math skills, reasoning ability with excellent written and verbal communication skills
• Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing
• Continuous learning to ramp up on the knowledge curve to be the SME and to be compliant with any certification as required to perform the job
• Be a team player and work seamlessly with other team members on meeting customer goals
• Developing and maintaining a solid working knowledge of the insurance industry and of all products, services and processes performed by Claims function
• Handle reporting duties as identified by the team manager
• Handle claims processing across multiple products/accounts as per the needs of the business
• Contribute effectively to process improvements that would improve Quality, Productivity & Customer Experience
• Actively engage on strategic initiatives as identified by the team manager

Skills Required