Description
We are seeking a Claims Processor to join our team. As a Claims Processor, you will be responsible for serving providers and insurance companies by determining requirements, answering inquiries, resolving problems, fulfilling requests, and maintaining databases.
Responsibilities and Duties
- Process claims from members and providers
- Assist queries from providers and payers via phone calls or emails
- Maintain files for authorizations and other reports
- Assess and process claims in line with policy coverage and medical necessity
- Be fully versed with medical insurance policies for various groups/beneficiaries
- May assist in training colleagues and sharing knowledge
- Accurately assess eligibility within policy boundaries
- Monitor and maintain claims processing as per defined terms and policy of the organization
- Achieve required processing targets assigned by the team leader on daily, weekly, and monthly basis
- Monitor qualitative and quantitative measures for claims and pre-approvals
- Ensure compliance with changes in system parameters or processes
- Maintain quality as per framework for accuracy
- Maintain productivity and responsiveness to allocated work
- Collaborate with other stakeholders/teams to resolve queries, including complex queries
- Actively support all team members to enable operational goals to be achieved
- Meet or exceed Service Level Agreement requirements, team KPI(s), monthly quality audit scores, and NPS (Net Promoter Score)
Requirements
- At least 1-2 years of experience performing a similar role
- Experience working for an international company preferred but not essential
- Claims processing or insurance experience preferred but not essential
- Broad awareness of medical terminology advantageous
- Excellent organizational skills, capable of following and contributing to agreed procedures
- Strong administration awareness and experience essential
- Strong skills in Microsoft Office applications essential
- First-class written and verbal communication skills essential
- Ability to communicate across a diverse population essential
- Capable of working independently or as part of a team
- Good time management, ability to work to tight deadlines
- Flexible and adaptable approach, sometimes working in a fast-paced environment
- Passion for achieving agreed objectives