Insurance Claim Specialist
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Key skills for this role
About the Role
We are hiring an Insurance Claim Specialist to process and manage insurance claims on a contractual basis. The role involves reviewing claim applications, assessing eligibility, and communicating with claimants.
Key Skills for This Role
Responsibilities
- Review and validate insurance claim applications for completeness and accuracy, ensuring all required documentation is provided.
- Assess claims against policy terms and conditions to determine eligibility and appropriate payout amounts.
- Communicate with claimants, healthcare providers, and third parties to gather additional information or clarify discrepancies.
- Maintain detailed records of claim processing activities, including updates and decisions, in the designated system.
- Escalate complex or unresolved claims to senior staff for review, following established protocols.
Requirements
- Minimum of 2 years of experience in insurance claim processing or a related administrative role, with a focus on accuracy and attention to detail.
- Proficiency in using claim management software and Microsoft Office Suite, particularly Excel for data entry and analysis.
- Strong understanding of insurance policies, terminology, and compliance requirements in the claims process.
- Ability to interpret medical or legal documents when relevant to claim evaluation, ensuring proper documentation is submitted.
- Excellent written and verbal communication skills, with the ability to interact professionally with claimants and stakeholders.
Full Job Posting
Role Overview
- We are hiring for one of our clients, seeking an Insurance Claim Specialist to work on a contractual basis.
- This role involves processing and managing insurance claims with accuracy and efficiency, ensuring compliance with company policies and regulatory standards.
Key Responsibilities
- Review and validate insurance claim applications for completeness and accuracy, ensuring all required documentation is provided.
- Assess claims against policy terms and conditions to determine eligibility and appropriate payout amounts.
- Communicate with claimants, healthcare providers, and third parties to gather additional information or clarify discrepancies.
- Maintain detailed records of claim processing activities, including updates and decisions, in the designated system.
- Escalate complex or unresolved claims to senior staff for review, following established protocols.
Required Skills & Qualifications
- Minimum of 2 years of experience in insurance claim processing or a related administrative role, with a focus on accuracy and attention to detail.
- Proficiency in using claim management software and Microsoft Office Suite, particularly Excel for data entry and analysis.
- Strong understanding of insurance policies, terminology, and compliance requirements in the claims process.
- Ability to interpret medical or legal documents when relevant to claim evaluation, ensuring proper documentation is submitted.
- Excellent written and verbal communication skills, with the ability to interact professionally with claimants and stakeholders.
More About the Opportunity
- This role offers the opportunity to contribute to a structured claims processing system, supporting a high volume workflow with clear performance metrics.
- The position is ideal for individuals with prior insurance experience seeking a flexible, remote contract engagement.
- Contract duration is project based, with potential for renewal based on performance and workload.
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