Health Insurance Claims Specialist
2 weeks ago
The Health Insurance Claims Specialist role is a critical position within our organization, playing a pivotal part in ensuring the smooth processing and resolution of health/accidental/life insurance claims. This individual will be responsible for overseeing the management and processing of these claims, guaranteeing accuracy, efficiency, and adherence to established guidelines and regulations throughout the claims process.
This specialist will work closely with stakeholders and internal teams to facilitate the efficient processing and resolution of claims, providing excellent customer service to policyholders and healthcare providers by addressing queries, concerns, and escalations related to claims. A professional and empathetic approach is essential when handling sensitive and challenging customer interactions.
Main Responsibilities:
- Manage the end-to-end process of health/accidental/life insurance claims through the insurance company/TPA, ensuring seamless communication and collaboration with relevant parties.
- Provide exceptional customer service to policyholders and healthcare providers, addressing their queries, concerns, and escalations in a timely and effective manner.
- Build and maintain strong relationships with insurance providers, healthcare professionals, and internal stakeholders to streamline communication and collaboration, resolving complex or disputed claims efficiently.
- Develop and implement quality assurance measures to ensure the accuracy and consistency of claims processed by the insurance company/TPA, conducting regular audits and reviews to identify areas for improvement and implementing corrective actions.
- Ensure proactive outreach to clients and stakeholders, maintaining open lines of communication to address their needs and concerns effectively.
Requirements
This role requires a highly motivated and organized individual with a keen eye for detail and a passion for delivering exceptional results. The ideal candidate will possess:
- A Bachelor's degree or equivalent experience in a related field.
- 1-3 years of experience in the Health Insurance industry or a similar customer service-oriented industry.
- Excellent communication and interpersonal skills, with the ability to build strong relationships with stakeholders and team members.
- Problem-solving and conflict resolution abilities, with a focus on finding creative solutions to complex problems.
- An analytical mindset, with the ability to gather and interpret data to inform decision-making.
- Proficiency in using relevant software applications and tools, with a willingness to learn and adapt to new technologies.
Salary
We offer a competitive salary range of $60,000-$80,000 per annum, depending on experience and qualifications. This is a full-time position with opportunities for career growth and professional development within our dynamic organization. We are committed to providing a supportive and inclusive work environment that fosters innovation, collaboration, and success.
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