Basic Function

As an associate / Sr. Associate in Claims Processing, your role is vital in ensuring accurate bill review and data entry items attached on email received in system. Their roles involves in decision making to match the correct bill, review the claim and data entry. This position requires a Lean approach, technical proficiency, and a proactive attitude toward innovation. You will manage intricate claims services functions, handle correspondence, and spearhead special projects across various lines of business.

Key

Responsibilities:

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  Ensure that the process transactions are processed as per Desktop procedures.
  
  
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  Ensure that the assigned targets are met in accordance with SLA and Internal standards.
  
  
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  Create and review Excel based trackers, review bills and claims, contacting claim handler.
  
  
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  Review and research correct claim number to attached documents.
  
  
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  File Copy pull documents from various claim systems and share with adjusters.
  
  
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  Manage complex claims processing functions, including process, and bill review.
  
  
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  Utilize related systems and technology proficiently to streamline processes.
  
  
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  Evaluate the impact of new releases, procedures, and suggestions.
  
  
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  Identify and address system errors, program malfunctions, workflow inefficiencies, or processing improvements by liaising with team leaders or supervisors.
  
  
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  Assist quality auditors as required and undertake additional responsibilities as assigned.
  
  
• Communicate with handler for any clarification/authorization, if required

Performance Parameters

• Productivity
• Quality
• Attendance
• Schedule Adherence

Any other essential function that may occur from time to time as directed by the Supervisor.

Primary Internal Interactions

• Subject Matter Expert for the purpose of process training, ramp, floor support, and any process-related query
• QCA for the purpose of audit feedback
• AM for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support.
• Manager for the purpose of settling issues left unresolved by the AM and monthly evaluation of performance.

Skills

Technical Skills

• Good computer navigation skills
• Good keyboarding speed (25 W.P.M.)
• Good knowledge of the complete MS Office suite specially Excel

Process Specific Skills

• Knowledge of US P&C insurance

Soft skills (Minimum)

• Communication skills (English) -Should be able to speak, read, interpret business documents & write business emails.
• Escalate issues if required.
• Teamwork/ Managing Self / Adaptability
• Ability to work successfully in a production driven environment.
• Adaptability to change.
• Ability to work on routine/standardized transactions

Soft Skills (Desired)

• Self-disciplined and result oriented.
• Ability to multitask.
• Ability to work effectively as part of a team.
• Open to work extra time as per business requirements.

Education Requirements

Graduation or diploma from a college or university with a minimum of fifteen (15) years of education

Work Experience Requirements

• Minimum six months of work experience in a related field is required.
• Experience in BPO (Claims transaction processing) or US P&C Insurance industry experience shall be preferred.
• Fresher college graduates can be considered.

Skills: claims handling

Experience: 0.00-0.00 Years