
Cashless Insurance Claims Professional
15 hours ago
About the Role:
The Claims Processing Specialist is responsible for efficiently and accurately handling cashless insurance claims, ensuring timely resolution for policyholders and seamless collaboration with insurance providers.
This position involves verifying policy coverage, reviewing medical records, coordinating with insurers, and ensuring accurate and efficient claim processing. The specialist may also communicate with employees or dependents to provide updates on claim status and address questions or concerns.
Key Responsibilities:
- Manage end-to-end cashless claims of employees, including verifying policy coverage and coordinating with insurers.
- Verify policy details to ensure claims are eligible for cashless processing according to terms and conditions.
- Provide customer service by responding to inquiries regarding claim status and related queries.
- Communicate with healthcare providers to obtain additional information and clarify details.
- Investigate and resolve discrepancies, errors, or issues arising during claim processing.
- Maintain detailed and accurate records of claim-related activities, communications, and transactions.
- Meet or exceed established service level agreements and performance metrics related to claim processing, turnaround time, accuracy, and customer satisfaction.
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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