Claims Adjuster
3 weeks ago
Duration: 06 Months (with a possibility of extension)
Client Domain: Insurance
The Claims Adjudicator is accountable for handling claims in accordance with high service standards to meet or surpass client expectations. The Adjudicator is required to make a number of determinations that may affect the member's entitlement to benefits and/or the amount of benefits that are payable. The Adjudicator reviews claims for completeness, enters, and assesses claims, and produces the final statement and/or payment responsibility, after the member's insurance benefits are applied to a claim.
Duties:
- Assesses highly complex health/dental claims in keeping with contract provisions, taking initiative and ensuring that empowered decision making is a key component of the process.
- Assume ownership of the claims assigned with an understanding of the urgency of specific cases and effectively prioritize work accordingly.
- Establish and maintain quality customer service within our turnaround times using influence with internal and external clients to meet all pre-established service standards in order to delight our customers.
- Commitment to Financial Efficiency and Continuous Improvement targets, as required.
- Commitment to improving NPS (customer) scores based on overall goals.
- Actively participate in various projects that improve effectiveness and efficiency in claims practices in keeping with our culture of continuous improvement.
- Manage all issues and requirements related to the claim to achieve customer/claim resolution handing off only as appropriate (claims adjustments, warranty investigation, technical decisions).
Qualifications:
- Post-secondary education preferred or equivalent experience.
- Exceptional Communication Skills: Proficient in both verbal and written communication for diverse internal and external audiences.
- Proficiency in Microsoft Office 365: Strong working knowledge of the Office 365 suite of programs.
- Detail-Oriented with Quick Assessment Skills: This role requires a keen eye for detail, as it involves reviewing receipts, extracting data, and accurately inputting information into the system. An analytical mindset is essential to understand and make decisions based on the information presented.
- Team and Individual Effectiveness: Proven ability to work effectively both independently and as part of a team in a fast-paced environment.
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