Positions General Duties and Tasks:• Process Insurance Claims timely and qualitatively• Meet & Exceed Production, Productivity and Quality goals• Review medical documents, policy documents, policy history, Claims history, system notes and apply the trained client level business rules to make appropriate Claims decisions, call out claims trends and flag fraud activities• Analyze customer queries to provide timely response that are detailed and ordered in logical sequencing• Cognitive Skills include language, basic math skills, reasoning ability with excellent written and verbal communication skills• Stay up to date on new policies, processes, and procedures impacting the outcome of Claims processing• Continuous learning to ramp up on the knowledge curve to be the SME and to be compliant with any certification as required to perform the job• Be a team player and work seamlessly with other team members on meeting customer goals• Developing and maintaining a solid working knowledge of the insurance industry and of all products, services and processes performed by Claims function• Handle reporting duties as identified by the team manager• Handle claims processing across multiple products/accounts as per the needs of the business• Contribute effectively to process improvements that would improve Quality, Productivity & Customer Experience• Actively engage on strategic initiatives as identified by the team managerRequirements for this role include:• Both Under Graduates and Post Graduates can apply.• Excellent communication (verbal and written) and customer service skills.• Able to work independently; strong analytic skills.• Detail-oriented; ability to organize and multi-task.• Ability to make decisions.• Required computer skills: must have experience with data entry and word processing, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications.• Demonstrate strong reading comprehension and writing skills.• Cognitive Skills include language, basic math skills, reasoning ability and verbal communication skills.• Ability to work in a team environment.• Handling different Reports - IGO/NIGO and Production/Quality.• To be in a position to handle training for new hires• Work together with the team to come up with process improvements• Strictly monitor the performance of all team members and ensure to report in case of any defaulters.• Encourage the team to exceed their assigned targets.**Required schedule availability for this position is Monday-Friday 6PM/4AM IST. The shift timings can be changed as per client requirements. Additionally, resources may have to do overtime and work on weekend's basis business requirement.Requirements for this role include:• Candidate should be flexible & support team during crisis period• Should be confident, highly committed and result oriented• Experience on working in an office environment set up utilizing Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools• Experience in a professional/office related role that required you to communicate (oral/written) effectively with internal team members and external customers• Experience in a role that required a focus on quality including attention to detail, accuracy, and accountability for your work product.• Candidate should be flexible to work from home and office environment. Broadband connection is must while working from home.Preferences for this role include:• 7+ years of experience processing insurance claims in the health, life, or disability disciplines that required knowledge of CPT, HCPCS, ICD9/10, CDT.• 2+ year(s) of experience in role that required understanding and interpreting complex documents such as medical records and legal contracts.
