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Claims Resolution Analyst
2 months ago
DESCRIPTION
This position will be responsible for processing and handling any claims that are incomplete or escalated for validation. This person will also be responsible for analyzing claims and making decisions about their validity. The position will be a communicator to internal and external business partners and a problem solver/agent for change to provide continuous improvements.
RESPONSIBILITIES
Process escalated claims, assess the reason for the escalation, and provide resolution in priority order as directed by the Supervisor.
Searches for and links invoices, contracts, and Proof of Performance to claims as needed.
Uses systems, reports, and Standard Operating Procedures to work assigned claim steps and gather supporting claims information.
Processes invalid claims in accordance with set policies and guidelines.
Corrects and resolves claims “clean passed” in error.
Researches validation issues and recommends appropriate solutions.
Reviews claims dashboard for actionable items on a frequent basis.
Meets or exceeds client and customer goals and requirements
Makes the final decision on claims validity for escalated claims
Sends compliant promotion package for clearing
Contacts Sales, clients, customers, and management team for information as needed.
Proactively managers client and customer target dates to ensure claims are processed in a timely manner.
Communicates with clients and customers on a regular basis and provides value-added solutions.
Escalates appropriately to the supervisor when needed to get information or handle complex client and customer situations.
Understands types of escalations and uses problem-solving and analytical skills to resolve them so they do not repeat.
Works to decrease defects and achieve automation (aka Ready to Clear) targets by keeping Standard Operating Procedures updated.
Monitors specific escalations data to determine the root cause of an escalation, where it originated and why it occurred.
Discusses defect issues with Sales, clients, customers, and management team and works with them to address the root cause.
Recognizes and provides solutions for operational obstacles that delay work completion on claims issues.
Meeting the physical requirements – listed below
Other duties as assigned
QUALIFICATIONS
Four years claims experience preferred
Food brokerage experience and/or clients’ experience in sales administration is strongly preferred
Relationship management experience preferred
Accepts accountability for job performance; proactively informs others when he/she encounters problems that may limit his/her ability to meet expectations
Accepts change as a normal part of doing business, maintains a positive attitude and exhibiting constructive work behaviors during periods of transition
Meets work and attendance expectation; informs others in advance when commitments cannot be fulfilled
Actively supports organizational goals and values; aligns actions around organizational goals; gives priority to organizational needs and concerns when making decisions
Takes a reasoned logical approach in making judgments and decisions, carefully reviews available facts and information before reaching any conclusions
Identifies and gathers relevant information, consults the right people and asks the right questions in a given situation
Demonstrates disciplined thinking that is clear, unbiased, analytical and informed by evidence
Effectively communicate with others.
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