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. QualificationsPossess 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.
