
Insurance Claims Resolution Specialist
2 days ago
About this role:
The Insurance Claims Resolution Specialist plays a pivotal role in ensuring the efficient and accurate processing of cashless insurance claims. This individual is responsible for verifying policy coverage, reviewing medical records, coordinating with Insurers, and guaranteeing timely closure to policyholders.
This includes:
- Verifying Policy Coverage: Review and verify policy details to ensure that the claim is eligible for cashless processing according to the terms and conditions of the insurance policy.
- Providing Customer Service: Respond to inquiries from employees, and other stakeholders regarding claim status, and any other related queries.
- Coordinating with Healthcare Providers/Hospitals: Communicate with healthcare providers to obtain additional information, clarify details, and resolve issues.
- Investigating and Resolving Discrepancies: Identify and resolve any discrepancies, errors, or issues that may arise during the processing of cashless claims.
- Maintaining Records: Keep detailed and accurate records of all claim-related activities, communications, and transactions for documentation and audit purposes.
- Meeting SLAs: Meet or exceed established service level agreements and performance metrics related to claim processing, turnaround time, accuracy, and customer satisfaction.
Our ideal candidate will possess excellent communication skills, attention to detail, and the ability to work effectively under pressure. They must be able to maintain confidentiality, handle multiple tasks simultaneously, and prioritize deadlines.
We offer a dynamic and supportive work environment that fosters growth and development. As an Insurance Claims Resolution Specialist, you will have the opportunity to make a real difference in the lives of our policyholders while advancing your career in a rapidly evolving industry.
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