
Senior Cashless Insurance Claims Coordinator
2 days ago
A Claims Management Specialist plays a pivotal role in ensuring timely and accurate processing of cashless insurance claims for policyholders.
This position involves efficiently managing end-to-end cashless claims, verifying policy coverage, reviewing medical records, coordinating with insurers, and ensuring seamless communication with employees or dependents.
Key Responsibilities:
- Cashless Claim Management: Manage cashless claims from start to finish, including verification of policy coverage, review of medical records, and coordination with healthcare providers and insurers.
- Policy Verification: Verify policy details to ensure that claims are eligible for cashless processing according to the terms and conditions of the insurance policy.
- Customer Service: Respond to inquiries from employees and stakeholders regarding claim status and related queries.
- Healthcare Provider Coordination: Communicate with healthcare providers to obtain additional information, clarify details, and resolve issues.
- Record Keeping: Maintain detailed and accurate records of all claim-related activities, communications, and transactions for documentation and audit purposes.
- Service Level Agreements: Meet or exceed established service level agreements and performance metrics related to claim processing, turnaround time, accuracy, and customer satisfaction.
- Experience: At least 2 years of experience in customer-facing roles.
- Prior Experience: Past experience in voice profiles would be an added advantage.
- Cashless/TPA Experience: Experience in cashless or TPA environments is essential.
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