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Claims Resolution Analyst
4 months ago
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. Process escalated claims, assesses the reason for the escalation, and provides 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 Education Bachelor's Degree Work Experience Four years of claims experience preferred Food brokerage experience and/or client experience in sales administration is strongly preferred Relationship management experience preferred Knowledge, Skills and Abilities 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 exhibits constructive work behaviors during periods of transition. Meets work and attendance expectations; informs others in advance when commitments cannot be fulfilled. Actively supports organizational goals and values; aligns actions around organizational goals; gives priority to organized needs and concerns when making decisions. Takes a reasoned logical approach in making judgements 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. Must be able to operate a calculator, computer, printer, fax machine, telephone, copier, and shredder. Physical Seeing Listening
