
Claims Specialist
2 weeks ago
As a Claims Specialist, you will play a vital role in our organization's mission to provide exceptional claims experience by streamlining processes and improving efficiency.
Key Responsibilities:
- Conduct regular reviews of current claims processes and develop new and improved processes to enhance our operational excellence.
- Effectively manage escalations and stakeholder relations to ensure seamless communication and conflict resolution.
- Provide ongoing training and development to enhance the skills of our claims management team.
- Liaise with insurance companies to verify exceptions and resolve complaints in a timely manner.
- Ensure claim settlement is concluded within the agreed turnaround time, adhering to regulatory compliance standards.
- Verify data entry processes for accuracy and adherence to our quality control measures.
Requirements:
- Strong technical knowledge of medical claims processing, including regulations and industry standards.
- Excellent interpersonal skills for effective stakeholder management and conflict resolution.
- Superior organizational skills and attention to detail to ensure accuracy and timeliness in claims processing.
- A passion for driving change and improving business outcomes through process improvements and strategic planning.
- Exceptional communication and stakeholder management skills to foster strong relationships with internal and external stakeholders.
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