Location
Noida | India
Job description
Roles & Responsibilities
- Provides plan and claim information, assists with submission of claims and makes outbound calls to gather missing information on incomplete claims.
- Conducts research when needed to resolve customer questions or complaints.
- Responds to telephone inquiries from insured’s regarding specific claim details.
- Understands processes within entire department to assist callers with questions and triage information received.
- Works closely with the Claims Reimbursement and Care Managers to provide a seamless customer experience.
- Outbound calls and letters to customers and providers to research incomplete claims.
- Escalate complaints and potential complaints appropriately
- Contributes ideas that enhance service quality.
- Performs project work and other related duties as assigned or required
Essential Functions:
- Analyze, validate and process transactions as per Desktop procedures (L3 & L4)
- Analyze and research all discrepancies
- Research & Investigate and resolve outstanding items
- Determine eligibility, entitlement and applicable plan provisions while meeting timeliness goals
- Clear and accurate written and verbal communication (Mix of scripted/unscripted) with employee, employer & stateside resources by email and outgoing calls
- Establish action plans for each file to bring claims to resolution
- Utilize internal and external specialty resources to maximize impact on each claim file
- Use PC programs to increase productivity and performance
- Ensure that the assigned targets are met in accordance with SLA and Internal standards
- Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process Excellence
- Work as a team member to meet office goals to obtain disability’s vision while demonstrating core values and
meeting key measures
- Ensure adherence to established attendance schedules
- Close visual activity - viewing a computer terminal and extensive reading
Any other essential function that may occur from time to time as directed by the Supervisor.
Primary Internal Interactions
- UM for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support
- Manager for the purpose of settling issues left unresolved by the AM and monthly evaluation of performance
- Subject Matter Expert for the purpose of work thread related issues and escalated transactions
- QCA for the purpose of feedback
- Trainers for the purpose of training
Primary External Interactions
- Interaction with Insureds via incoming and outgoing calls information gathering/ claim queries
- Claims specialist & other Stateside Teams on emails/calls
- SME / Trainers at the client end for training
Organizational Relationships
Reports To:
AM, LTC Claims Process – Claim Support Services
Supervises:
Job tags
Salary
