Hc & Insurance Operations Senior Representative

In this Role you will be Responsible For• Review and process insurance claims.• Validate Member, Provider and other Claims information.• Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure.• Coordination of Claim Benefits based on the Policy & Procedure.• Maintain productivity goals, quality standards and aging timeframes.• Scrutinizing Medical Claim Documents and settlements.• Organizing and completing tasks per assigned priorities.• Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the tea• Resolving complex situations following pre-established guidelinesRequirements for this role include:• 0 -1 year of experience in any Healthcare BPO• University degree or equivalent that required 3+ years of formal studies• 1+ year(s) of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools.• Ability to work scheduled shifts from Monday-Friday 06:00 PM to 04:00 AM (weekend's if required) and to be flexible to accommodate extra hours due to business requirements• Ability to communicate (oral/written) effectively in English to exchange information with our client.