CLAIMS ADJUSTMENT SPECIALIST

5 days ago


Hyderabad Telangana India, Telangana ADP Full time

Job Description: CLAIMS ADJUSTMENT SPECIALIST

Responsibilities:


The Claim Adjustment Specialist is responsible for end-to-end validation, reviewing and responding to all requests and questions with respect to Risk Management-related issues which include workers’ compensation claims. Provide direct assistance on all claim-related questions or requests. Take ownership of the question or request and ensure the question or request is properly handled or documented.

  • Coordinate with TPA on claim issues and concerns while providing claim oversight.
  • Accurately document claim activities and maintain up to date records in claim management system.
  • Review claim forms, supporting documents and customer information.
  • Validate claim eligibility based on policy coverage, limits and conditions.
  • Identify discrepancies, missing information or fraud indicators.
  • Meet TAT, accuracy and SLA targets.


Skills Required:

  • Strong Analytical skills and attention to detail
  • Attention to detail
  • Excellent Communication skills


Preferred Experience:

  • 1-2 years of experience in Claims Management or Claims processing is mandatory



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