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Claims Validation Specialist

2 months ago

Tampa, Florida, United States Acosta Full time
Descripción del Trabajo

Este puesto será responsable de gestionar y procesar cualquier reclamación que esté incompleta o que haya sido escalada para validación. La persona en esta posición también se encargará de analizar las reclamaciones y tomar decisiones sobre su validez. Este rol será un comunicador entre socios comerciales internos y externos, así como un solucionador de problemas y agente de cambio para proporcionar mejoras continuas.

Responsabilidades
  • Gestionar reclamaciones escaladas, evaluar la razón de la escalada y proporcionar una resolución en orden de prioridad según lo indicado por el Supervisor.
  • Buscar y vincular facturas, contratos y Pruebas de Desempeño a las reclamaciones según sea necesario.
  • Utilizar sistemas, informes y Procedimientos Operativos Estándar para trabajar en los pasos asignados de las reclamaciones y recopilar información de respaldo.
  • Procesar reclamaciones inválidas de acuerdo con las políticas y directrices establecidas.
  • Corregir y resolver reclamaciones que hayan pasado como "limpias" por error.
  • Investigar problemas de validación y recomendar soluciones apropiadas.
  • Revisar el panel de control de reclamaciones para identificar elementos accionables de manera frecuente.
  • Cumplir o superar los objetivos y requisitos de clientes y consumidores.
  • Tomar la decisión final sobre la validez de las reclamaciones escaladas.
  • Enviar un paquete de promoción conforme para su aprobación.
  • Contactar a Ventas, clientes, consumidores y el equipo de gestión para obtener información según sea necesario.
  • Gestionar proactivamente las fechas objetivo de clientes y consumidores para asegurar que las reclamaciones se procesen de manera oportuna.
  • Comunicar regularmente con clientes y consumidores y proporcionar soluciones de valor agregado.
  • Escalar adecuadamente al supervisor cuando sea necesario para obtener información o manejar situaciones complejas de clientes y consumidores.
  • Comprender los tipos de escalaciones y utilizar habilidades de resolución de problemas y análisis para resolverlas y evitar que se repitan.
  • Trabajar para disminuir defectos y alcanzar objetivos de automatización manteniendo actualizados los Procedimientos Operativos Estándar.
  • Monitorear datos específicos de escalaciones para determinar la causa raíz de una escalación, su origen y por qué ocurrió.
  • Discutir problemas de defectos con Ventas, clientes, consumidores y el equipo de gestión y trabajar con ellos para abordar la causa raíz.
  • Reconocer y proporcionar soluciones para obstáculos operativos que retrasen la finalización del trabajo en problemas de reclamaciones.
  • Cumplir con los requisitos físicos - listados a continuación.
  • Otras tareas según se asignen.
Calificaciones

Educación
  • Título universitario.
Experiencia Laboral
  • Se prefieren cuatro años de experiencia en reclamaciones.
  • Se prefiere experiencia en corretaje de alimentos y/o experiencia de cliente en administración de ventas.
  • Se prefiere experiencia en gestión de relaciones.
Conocimientos, Habilidades y Capacidades
  • Acepta la responsabilidad por el desempeño laboral; informa proactivamente a otros cuando se encuentra con problemas que pueden limitar su capacidad para cumplir con las expectativas.
  • Acepta el cambio como una parte normal del negocio, mantiene una actitud positiva y exhibe comportamientos laborales constructivos durante períodos de transición.
  • Cumple con las expectativas de trabajo y asistencia; informa a otros con anticipación cuando no pueda cumplir con los compromisos.
  • Apoya activamente los objetivos y valores organizacionales; alinea sus acciones en torno a los objetivos organizacionales; da prioridad a las necesidades y preocupaciones organizacionales al tomar decisiones.
  • Toma un enfoque razonado y lógico al tomar juicios y decisiones, revisando cuidadosamente los hechos y la información disponible antes de llegar a cualquier conclusión.
  • Identifica y recopila información relevante, consulta a las personas adecuadas y formula las preguntas correctas en una situación dada.
  • Demuestra un pensamiento disciplinado que es claro, imparcial, analítico e informado por evidencia.
  • Se comunica de manera efectiva con los demás. Debe ser capaz de operar una calculadora, computadora, impresora, fax, teléfono, copiadora y destructora de documentos.
Requisitos Físicos
  • Visión.
  • Escucha.