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Claims Specialist
2 months ago
Work Hours: Monday-Friday, 8 AM to 4:45 PM ROLE: Claims Specialist
ROLE SUMMARY:The Claims Specialist will be responsible in processing life, disability, and waiver of premium claims by providing patient, empathetic, customer service to policy-related personnel regarding their claim. This is handled via telephone, e-mail, fax, or by sending letters through the mail. In addition, perform the various claim functions as listed below.
DAILY RESPONSIBILITITES:
- Collecting information through handling incoming calls, ensuring timely and courteous verification.
- Inform clients about processes, procedures, and expectations in a clear and helpful manner.
- Coordinate the necessary documentation for claims processing, utilizing both internal systems and external resources.
- Generate letters and update claim systems for newly reported claims.
- Address and follow up on outstanding requirements for pending claims, resolving them efficiently.
- Investigate and gather essential data from various sources such as beneficiaries, physician records, medical facilities, legal documents, etc., to facilitate effective claims processing.
- Record detailed notes related to interactions with policy-related personnel.
- Effective communication skills, both written and verbal.
- Proficiency in handling multi-line phone systems, with the ability to route and escalate calls as required.
- Exceptional interpersonal skills, fostering positive relationships.
- • Strong organizational and time management capabilities.
- • Patient and empathetic demeanor.
- • Active listening skills.
- • Adaptability and flexibility in dynamic work environments.
- • Comfortable working within fast-paced settings.
- • Troubleshooting skills, varying from basic to advanced based on role and industry.
- • Proficient computer skills, including data entry proficiency.
- • Adherence to all applicable laws, regulations, and contractual obligations while conducting company business with ethics and integrity, aligning with the Compliance Program principles.
