Job Description

Department: Operations Role - Executive/Sr. Executive Reports to: Assistant manager : Team would be responsible for the timely and accurate resolution of Health Screening claims and Sickness claims based on claims philosophy, policy guidelines, and state regulations, must be able to communicate health screening decisions and processes to customers in a clear, concise manner. This position lays the groundwork for customer communication both by mail and phone regarding claim information. It is the VBS Associate\'s responsibility to support customer service goals both internally and externally Organizational Relationships Reports To: Assistant Manager Supervises: NA Skills Technical Skills Graduate with at least 2+ years of experience (Industry + BPO) 3+ years prior experience in Claims processing Experience in L&A Insurance preferred Research methods, techniques, sourcing information Detail oriented able to analyze and research policy information Ability to negotiate and deal effectively with conflict in a professional manner Ensure that departmental standards pertaining to production, quality, timeliness and customer service are met Able to utilize claim investigative techniques to identify and evaluate claim information in a fair and objective manner Able to hold fast to fair and appropriate decisions even in the face of disagreement while being open to reconsider previous decisions based on new information Knowledge of US Insurance /Medical Claims/US Healthcare is preferable In depth knowledge of medical terminology and body systems Ability to interpret medical records, correlate clinical knowledge with available medical data to synthesize and create medical summary as per product guidelines Better understanding of general liability and MVA related disease/injuries like fractures/sprains/strains Understanding of lifestyle disorders like diabetes, hypertension, obesity, etc. that complicates the normal line of treatment of fracture/pain/soft tissue injuries (helpful in creating treatment plan and recommendations) Preferred experience in identifying suspicious issues, claim value drivers and mitigating factors Able to differentiate subjective and objective findings in medical records. Proficiency in written English and ability to paraphrase without altering the meaning of the medical text computer literacy - Basic IT knowledge and familiarity of operating systems (Windows) Basic Knowledge of using Internet, web browser, search engine, Microsoft excel and word Typing skills - 25 words per minute with 90% accuracy Process Specific Skills Review of medical records and abstract relevant information Identifying discrepancies, suspicious issues, negligence, and preexisting comorbidities Soft skills (Desired) Adaptability Eagerness to learn/flexibility to change Openness to feedback Teamwork Business Awareness Managing self Customer focus Desire to excel and improve Soft Skills (Minimum) Self-motivated, team player Problem solving skills Analytical ability Good Communication written and oral Education Requirements Preferred medical education background -BDS, BHMS, BAMS, BPT, and MPTs,

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