Job Summary
We are seeking a skilled professional with 2 to 4 years of experience in Claims Adjudication for the role of SPE-Claims HC. The ideal candidate will work from our office during night shifts focusing on ensuring accurate and efficient claims processing. Experience in Commercial Claims is a plus contributing to the enhancement of our claims management system.
Responsibilities
Oversee the claims adjudication process to ensure accuracy and compliance with company standards.Analyze claims data to identify trends and areas for improvement in claims processing.Collaborate with team members to streamline claims workflows and enhance efficiency.Provide insights and recommendations to improve the claims adjudication system.Ensure all claims are processed within the stipulated time frames to maintain customer satisfaction.Coordinate with other departments to resolve complex claims issues effectively.Maintain up-to-date knowledge of industry regulations and standards related to claims adjudication.Utilize technical skills to troubleshoot and resolve any system issues impacting claims processing.Monitor and report on key performance indicators related to claims adjudication.Assist in the development and implementation of training programs for new team members.Contribute to the continuous improvement of claims processes through innovative solutions.Engage in regular reviews of claims procedures to ensure best practices are followed.Support the team in achieving departmental goals and objectives.Qualifications
Possess a strong understanding of claims adjudication processes and systems.Demonstrate experience in handling commercial claims is advantageous.Exhibit excellent analytical skills to interpret claims data effectively.Show proficiency in using claims management software and tools.Display strong communication skills to collaborate with cross-functional teams.Have a keen eye for detail to ensure accuracy in claims processing.Be adaptable to work night shifts and manage workload efficiently.Certifications Required
Certified Claims Professional (CCP) or equivalent certification in claims management.
