claims adjustment specialist
6 days ago
Job Description
: CLAIMS ADJUSTMENT SPECIALIST
Responsibilities:
The Claim Adjustment Specialist is responsible for end-to-end validation, reviewing and responding to all requests and questions with respect to Risk Management-related issues which include workers' compensation claims. Provide direct assistance on all claim-related questions or requests. Take ownership of the question or request and ensure the question or request is properly handled or documented.
- Coordinate with TPA on claim issues and concerns while providing claim oversight.
- Accurately document claim activities and maintain up to date records in claim management system.
- Review claim forms, supporting documents and customer information.
- Validate claim eligibility based on policy coverage, limits and conditions.
- Identify discrepancies, missing information or fraud indicators.
- Meet TAT, accuracy and SLA targets.
Skills Required:
- Strong Analytical skills and attention to detail
- Attention to detail
- Excellent Communication skills
Preferred Experience:
- 1-2 years of experience in Claims Management or Claims processing is mandatory
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