Claims Operations Analyst – Commercial Insurance

3 days ago

Quezon City, National Capital Region, Philippines ECLARO Full time ₱900,000 - ₱1,200,000 per year

Role Title:
Claims Operations Analyst - Commercial Insurance
ECLARO:
A quick Summary

ECLARO is an award-winning professional services firm headquartered in New York City and operating in the U.S., Canada, UK, Ireland, Australia and the Philippines. We are dedicated to a singular purpose: providing the Right People to meet every client's needs and solve business challenges through strategic staffing, permanent placement, custom outsourcing & offshoring. Utilizing our proprietary TRINIT-E Service Maturity Model, we help clients implement programs to promote innovation, automation and process improvement.

Responsibilities & Accountabilities:

  • Intake, triage, route and assign claims to appropriate resources.
  • Comply with all regulatory requirements, company mandates and policies.
  • Prepare claims correspondence in accordance with company standards and regulatory requirements.
  • Properly document claim files, including notes and diaries, claims documents and claimant details.
  • Manage and update claims information for changes in status, parties, notifications, filings, etc.
  • Complete claims financial transactions including claim payments, vendor invoices, attorney expenses, etc.
  • Process and document returned checks, voided checks, credits, and other financial transactions.
  • Assist with the management of OFAC and other sanctions clearance on claims indemnity and expense payments.
  • Serve are primary contact for incoming calls and research and resolve inquiries promptly or escalate to the appropriate team member when necessary
  • Escalate urgent or complex matters to appropriate adjusters or supervisors
  • Support process improvements and provide feedback to enhance FNOL workflows and customer experience
  • Contribute to quality assurance and meet performance metrics for all FNOL

Ideal Candidate Profile:

  • Bachelor's degree preferred or equivalent healthcare experience.
  • Strong verbal and written communication skills required
  • Strong attention to detail and accuracy in data entry
  • 5+ years in Commercial Claims preferred or equivalent healthcare experience.
  • Preferred healthcare background in Nursing, Physician's Aid, Emergency Medical Technician and has familiarity with medical terminology used in first notices of loss.
  • Preferred previous experience in medical coding of healthcare claims.
  • Ability to exercise independent judgment and make critical business decisions effectively.

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