Job Summary
The TL-Ins Claims role requires a seasoned professional with 5 to 8 years of experience in the Data & Analytics Business. The candidate should have strong experience in claim adjudication claim manager role or medical coding - Healthcare/Insurance. Associate should have 2+ years experience in handling 20 -30 members teams This office-based position operates during night shifts requiring proficiency in English for effective communication.
Responsibilities
- Oversee the claim investigation process to ensure thorough validation and accurate adjudication.
- Utilize advanced Excel skills to analyze data and generate insightful reports for claim assessments.
- Collaborate with cross-functional teams to streamline claim processing and improve efficiency.
- Ensure compliance with industry regulations and company policies during claim evaluations.
- Provide detailed analysis and feedback on claim trends and patterns to support business decisions.
- Develop strategies to enhance the accuracy and speed of claim adjudication processes.
- Monitor claim processing metrics to identify areas for improvement and implement corrective actions.
- Facilitate training sessions for team members to enhance their skills in data analytics and claim validation.
- Maintain up-to-date knowledge of industry standards and best practices in claim investigation.
- Communicate effectively with stakeholders to provide updates on claim status and resolution timelines.
- Implement innovative solutions to optimize the use of data analytics in claim management.
- Support the development of automated systems for efficient claim processing and reporting.
- Ensure high-quality service delivery by adhering to established protocols and procedures. Qualifications
- Possess strong analytical skills with proficiency in advanced Excel for data manipulation and reporting.
- Demonstrate expertise in claim investigation and validation processes ensuring accurate adjudication.
- Exhibit excellent communication skills in English both written and spoken for effective stakeholder engagement.
- Have a solid understanding of industry regulations and compliance requirements related to claims.
- Show ability to work effectively in night shifts within an office-based environment.
- Display experience in collaborating with cross-functional teams to achieve business objectives.
- Present a proactive approach to problem-solving and process improvement initiatives.
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