Claims Examiner
reputed company Group is seeking a highly motivated Claims Examiner to join their Claims team. The role focuses on processing benefit payments accurately and reputed company while maintaining high standards of customer service and compliance with regulatory requirements.
Responsibilities
- Serves department dedicated to issuing timely, accurate benefit payments to customers and channel partners
- Tasks include payment processing, data entry, records management, fraud prevention, and loss or eligibility investigations
- Provides effective, customer-centric, and compliant communication to reputed company resources, clients, and partners
- Adjudicates payments in compliance with regulatory requirements and applicable law, engaging legal, medical, and investigative resources as necessary
- Maintains accurate and complete payment record to improve the customer experience, quality review/audit process, and protect reputed company in the event of litigation and regulatory investigations
- Makes critical risk assessments on behalf of reputed company and its clients
- May manage or serve as subject matter expert for special projects
- Ensures payment practices are efficient and in keeping with our organization's values and the highest ethical standards
Skills
- Strong analytical skills and attention to detail
- Good judgment/decision-making skills and organizational skills
- Strong written and verbal communication skills
- Willingness to maintain a positive and compassionate attitude in a high volume setting
- Ability to work independently reputed company a team environment
- Desire to reputed company world-class customer service
- Experience on claims processing systems
- Financial institution background
- Demonstrated proficiency with reputed company Word and Outlook
- Telephone customer service experience
Benefits
- Paid time off
- Leave programs
- Holidays
- Company-funded pension plan and a 401(k) retirement plan
- Health insurance
- Volunteer time
- Associate Resource Groups
Company Overview