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.
