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Job Summary
TheSenior Claims Executivewill additionally handle complex cases, mentor junior staff, and support claims process improvements.
Key Responsibilities
Handle complex or high-value claims, providing in-depth analysis and investigation as necessary.
Review and approve claims processed by junior staff, ensuring accuracy and adherence to company policies.
Mentor and train junior Claims Executives on claims handling procedures and best practices.
Collaborate with management to implement process improvements and develop streamlined claims workflows.
Conduct periodic audits of claims to ensure compliance with industry regulations and internal standards.
Act as a primary point of contact for escalated claims issues, working closely with healthcare providers, insurers, and clients to resolve disputes.
Key Requirements
Education and Experience:
Diploma or bachelor's degree in healthcare, Business Administration, Finance, or related field.
Senior Claims Executive:3-5 years of experience in healthcare claims processing, with exposure to complex claims management and team leadership.
Familiarity with healthcare claims systems and regulations is preferred.
Skills:
Strong attention to detail and accuracy in reviewing and processing claims.
Excellent communication skills, with the ability to handle sensitive healthcare and financial information confidentially.
Proficiency in MS Office Suite, especially Excel, for record-keeping and reporting.
Analytical thinking and problem-solving abilities, especially for handling complex claims (Senior role).
Ability to work effectively in a fast-paced environment, with strong time management skills.
Attributes:
Customer-oriented with a professional demeanor in handling claims inquiries.
Proactive and adaptable, with a commitment to continuous improvement.
Leadership qualities, including the ability to mentor and guide junior staff.#J-18808-Ljbffr