Claims Representative
- Bangalore, Karnataka
- Permanent
- Full-time
- International insurance claims processing for Member claims.
- Delivers basic technical, administrative, or operative Claims tasks. Examines and processes paper claims and/or electronic claims. Completes data entry, maintains files, and provides support. Understands simple instructions and procedures. Performs Claims duties under direct instruction and close supervision. Work is allocated on a day-to-day or task-by-task basis with clear instructions. Entry point into professional roles.
- Adjudicate international pharmacy claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals.
- Monitor and highlight high-cost claims and ensure relevant parties are aware.
- Monitor turnaround times to ensure your claims are settled within required time scales, highlighting to your Supervisor when this is not achievable.
- Respond within the time commitment given to enquiries regarding plan design, eligibility, claims status and perform necessary action as required, with first issue/call resolution where possible.
- Interface effectively with internal and external customers to resolve customer issues.
- Identify potential process improvements and make recommendations to team senior.
- Actively support other team members and provide resource to enable all team goals to be achieved.
- Work across International business in line with service needs.
- Carry out other ad hoc tasks as required in meeting business needs.
- Work cohesively in a team environment.
- Adhere to policies and practices, training, and certification requirements.
- Working knowledge of the insurance industry and relevant federal and state regulations.
- Good English language communication skills, both verbal and written.
- Computer literate and proficient in MS Office.
- Excellent critical thinking and decision-making skills.
- Ability to meet/exceed targets and manage multiple priorities.
- Must possess excellent attention to detail, with a high level of accuracy.
- Strong interpersonal skills.
- Strong customer focus with ability to identify and solve problems.
- Ability to work under own initiative and proactive in recommending and implementing process improvements.
- Ability to organise, prioritise and manage workflow to meet individual and team requirements.
- Experience in medical administration, claims environment or Contact Centre environment is advantageous but not essential.