Claims Processing Specialist

Purpose of the Role:
The Claims Processing Associate is responsible for reviewing, verifying, and processing insurance claims accurately and efficiently. This role ensures timely claim resolution while maintaining compliance with company policies and industry regulations.

Key Responsibilities:

• Review, verify, and process insurance claims in a timely manner.
• Assess claim documents to ensure all required information is provided and accurate.
• Evaluate claims to determine eligibility, coverage, and liability.
• Maintain accurate and organized records of claims processed.
• Communicate with policyholders, claimants, and vendors to gather necessary information or clarify details.
• Respond to inquiries related to claims status and other related queries.
• Ensure all claims are processed in compliance with company policies, regulatory requirements, and industry standards.
• Identify discrepancies, errors, or potential fraud, and report them to the appropriate departments.
• Collaborate with the claims team to resolve complex claims issues and disputes.
• Ensure timely follow-up on pending claims to meet deadlines and customer satisfaction goals.
• Prepare and submit periodic reports on claims processed, including trends, volumes, and outstanding claims.
• Assist in identifying opportunities for process improvements.

Education Qualification(s)- Any Graduate

Relevant Skills

- Strong attention to detail and organizational skills.
- Excellent communication skills, both written and verbal.
- Ability to handle multiple tasks and work effectively under deadlines.
- Basic knowledge of Microsoft Office Suite (Excel, Word, Outlook).