
Claims Administrator
1 day ago
About our organization:
We are seeking a skilled Claims Management Specialist to join our team. This role involves efficiently and accurately processing cashless insurance claims, ensuring timely closure to policyholders and seamless coordination with insurance providers.
The primary objective of this position is to process and manage cashless claims for employees, verifying policy coverage, reviewing medical records, coordinating with Insurers, and ensuring accurate and efficient claim processing.
Key Responsibilities:
- Manage employee cashless claims from start to finish, including verification of policy coverage, review of medical records, and coordination with Insurers.
- Verify Policy Coverage: Review and verify policy details to ensure claim eligibility according to insurance policy terms and conditions.
- Provide Customer Service: Respond to inquiries from employees and stakeholders regarding claim status and related queries.
- Coordinate with Healthcare Providers/Hospitals: Communicate with healthcare providers to obtain additional information and clarify details.
- Resolve Issues: Investigate and resolve discrepancies, errors, or issues during claim processing to ensure timely and accurate resolution.
- Maintain Records: Keep detailed and accurate records of claim-related activities, communications, and transactions.
- Meet Service Level Agreements: Meet or exceed established service level agreements and performance metrics related to claim processing, turnaround time, accuracy, and customer satisfaction.
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