Claims Representative

Role Overview

This position involves delivering excellent Tier 2 customer support via inbound calls, emails, and chats, emphasizing timely issue resolution, high customer satisfaction, and compliance with service protocols.

Key Responsibilities

• Provide assistance to customers by addressing their inquiries and offering suitable guidance.
• Ensure detailed and accurate documentation of customer interactions.
• Escalate unresolved issues to internal departments as required.
• Process health insurance claims efficiently, adhering to established deadlines.
• Thoroughly review claim data, member information, and accompanying documents to ensure completeness and correctness.
• Validate claims in line with pertinent health insurance policies and processing rules.
• Identify discrepancies such as missing or inconsistent information and execute corrective actions.
• Maintain up-to-date and accurate claim records within designated systems.
• Conduct basic research and follow standard operating procedures for claim handling.
• Respond to claim-related questions by providing accurate information based on procedural guidelines.