Analyze reported lower - level general liability claims for Sedgwick. Ensure ongoing adjudication of claims within company standards and industry best practices while working in a hybrid schedule.
TS
Hybrid Insurance Claims Representative
Posted 2 weeks ago
About the role
- Claims Representative Agent supporting a Health Insurance client company. Handling various claims support tasks and providing expertise in a fast-paced operational environment.
Responsibilities
- Provide expertise or general claims support by reviewing, researching, processing, and adjusting claims
- Handling different work types like claim adjustment work including Calltraks/Onbase
- Processing different type of Dental claims on CPS Jacada Platform
- Analyze and identify trends and provide reports as necessary
- Consistently meet established productivity, schedule adherence and quality standards
- Authorizes the appropriate payment or refers claims to investigators for further review
- Conducts data entry and claims processing/issues
- Handling issues within turnaround standards
- Ability to handle most claim types / cases / issues that are submitted to the team you are supporting
- Ability handle escalations as needed
- Ability to work multiple functions and applications in a day as needed
- Communicate any changes in trending of inventory, volumes, and quality remediation
- Meet and maintain minimum quality and productivity standards
- Other functions may apply
Requirements
- 1+ years of experience in a production environment
- Proficient in MS Office with solid computer skills (e.g. multiple systems experience, keyboarding skills, Microsoft word, Power Point)
- Proficient in verbal and written English skills
- Willing or able to work 40 hours / week during standard business operating hours Monday - Friday from 7am - 7pm AST (It may be necessary, given the business need, to work occasional overtime on weekends and holidays)
Job title
Job type
Experience level
Salary
Degree requirement
No Education Requirement
Location requirements
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