Claims Specialist
3 days ago
POSITION OVERVIEW
Claims Processors are involved in managing a claim from beginning through to settlement. They ensure that claims are handled efficiently and that payment for valid claims is made to their policyholders. Claims Processors decide on the extent and validity of a claim by checking for any potential fraudulent activity. They liaise with external experts such as loss adjusters and lawyers and may be involved in legal discussions about the recovery of money from the party responsible for the loss. Claims Processors do much more than simply fill out paperwork. They have to analyze the data that they are given to recommend an informed decision and keep with their company's standards
POSITION DESCRIPTION
- Interact with customers and act as a liaison between clients and companies by providing information to address inquiries regarding products and services
- Assist and help resolve any client inquiries, errors, account questions, billing, cancelations, and other queries about products and services
- Answer questions, offer advice, resolve routine problems in service, and serve as advocates for client's customer service brand
- Process new Claims policies, modify existing ones and obtain information from policyholders to verify the accuracy of their accounts
- Calculate the amounts of claims, apply rating systems to claims, contact people involved in claims to obtain relevant information and recommend claim actions
- Assist claimants, providers and clients with problems or questions regarding their claims and/or policies whilst complying with state laws, policy and company procedures
- Listening attentively to customer needs and concerns; demonstrate empathy while maximizing opportunity to build rapport with the customer
- Confirm customer understanding of the solution and provide additional customer education as needed
- Make follow up outbound calls to customers and other parties as a part of case resolution process
- Ensure all client enquiries are recorded into the system, confirming all contact details of the enquirer with 100% accuracy
- Reviews claims thoroughly and to makes sure that all information are complete and correct; updates records of claims and follow up on lapsed cases
- Provide well-rounded, prompt, high-quality, and professional client service at all times
- Any other task/duty as directed by client/management
POSITION REQUIREMENTS
- Candidate must possess at least an Associate's or Bachelor's/College Degree
- With at least 2 years of work experience in a similar role
- Proficient in using Microsoft Office applications and is tech savvy
- Previous experience in the healthcare industry is an advantage
- Ability to be flexible, adaptable and adjust in a fast-paced work environment
- Excellent command of the English language, and is an effective communicator both orally and written
- Strong customer service orientation and people skills
- Must have patience, empathy and self-control to deal with angry, emotional or frustrated clients
- High critical thinking skills such as reasoning, logic and judgment to solve a variety of coverage-related issues
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