Claims Representative

YOUR JOB

Delivers basic technical, administrative, or operative Claims tasks. Examines and processes paper claims and/or electronic claims from Healthcare Providers. Completes data entry, maintains files, and provides support. Understands simple instructions and procedures. Performs Claims duties under direct instruction and close supervision. Work is allocated on a day-to-day or task-by-task basis with clear instructions. Entry point into professional roles.

What are your main Duties/Responsibilities:  

• Adjudicate international medical/dental and vision claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals. 
• Monitor and highlight high cost claims and ensure relevant parties are aware. 
• Monitor turnaround times to ensure your claims are settled within required time scales, highlighting to your Supervisor when this is not achievable. 
• Respond within the time commitment given to enquiries regarding plan design, eligibility, claims status and perform necessary action as required, with first call resolution where possible. 
• Interface effectively with internal and external customers to resolve Provider issues. 
• Have full ownership of Provider’s Country Cluster assigned.
• Identify potential process improvements and make recommendations to team senior. 
• Actively support other team members and provide resource to enable all team goals to be achieved. 
• Work across European business in line with service needs. 
• Carry out other adhoc tasks as required meeting business needs.

YOUR PROFILE

• Customer focused with ability to identify and solve problems.
• Ability to meet/exceed targets and manage multiple priorities. 
• Proficient in Microsoft Office applications. 
• Preferred if English and Arithmetic qualification gained. 
• Experience in medical administration, claims environment is advantageous but not essential. 
• Diploma or Degree in a business or related field is required.

KEY COMPETENTIES: 

• Must possess excellent attention to detail, with a high level of accuracy. 
• Strong interpersonal skills with good verbal and written communication to internal and external clients. 
• Strong customer focus with ability to identify and solve problems. 
• Ability to work under own initiative and proactive in recommending and implementing process improvements. 
• Ability to organize, prioritize and manage workflow to meet individual and team requirements. 
• Ability to exercise judgement.