Claims Excellence

Key Responsibilities:

• Ensure accurate data entry and documentation of claim details in the claims management system.
• Review claims for completeness and compliance with policy terms and conditions.
• Coordinate with internal departments to gather missing documentation or information.
• Flag potential discrepancies or anomalies for further review.
• Maintain confidentiality and adhere to data protection standards while handling sensitive health information.
• Respond to basic inquiries from policyholders regarding claim status and documentation requirements.
• Ensure timely processing of claims to meet service level agreements (SLAs).
• Assist in generating reports for internal tracking and audit purposes.
• Support continuous improvement initiatives in claims processing workflows.
• Participate in training sessions related to claims systems and regulatory updates.
• Service and resolve inquiries from customers, members, beneficiaries, and others regarding health care products and benefits across multiple product lines.
• Communicate effectively across multiple channels, including phone, e-mail, chat, and text.
• Collect information succinctly from a customer to set up a new claim.
• Gather information from multiple source systems to understand and articulate the status of a claim and next steps in processing.

Qualifications:

• Bachelor's degree in Insurance, Business Administration, Healthcare Management, or related field.
• Basic understanding of health insurance products and claims lifecycle.
• Proficiency in Microsoft Office and claims management software.
• Strong attention to detail and organizational skills.