
Insurance Claim Resolution Professional
8 hours ago
About Position:
Claims Specialists play a pivotal role in processing and managing insurance claims efficiently and accurately. Their primary responsibility is to ensure timely resolution of claims and seamless coordination with insurance providers.
The primary function of a Claims Specialist is to process and manage insurance claims for employees, including verifying policy coverage, reviewing medical records, coordinating with Insurers, and ensuring accurate and efficient processing.
Key Responsibilities:
- Manage end-to-end insurance claims, including verifying policy coverage, reviewing medical records, coordinating with Insurers, and ensuring accurate and efficient processing.
- Verify Policy Coverage: Review and verify policy details to ensure claim eligibility according to terms and conditions of the insurance policy.
- 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, clarify details, and resolve discrepancies.
- Maintain Records: Keep detailed and accurate records of all claim-related activities, communications, and transactions for documentation and audit purposes.
Interactions:
- Internal Clients: Endorsement team, Onboarding team, Products & engineering, Claims teams, Support Inbound, Account Management
- External Clients: Insurers, Client HR's, Hospitals
Requirements:
- At least 2 years of experience in customer-facing roles
- Past Experience in voice profile would be an added advantage
- Experience in cashless/TPA
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