Hc Insurance Operations Senior Representative

In this Role you will be Responsible For
. Review and process insurance claims.
. Validate Member, Provider and other Claims information.
. Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure.
. Coordination of Claim Benefits based on the Policy & Procedure.
. Maintain productivity goals, quality standards and aging timeframes.
. Scrutinizing Medical Claim Documents and settlements.
. Organizing and completing tasks per assigned priorities.
. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the tea
. Resolving complex situations following pre-established guidelines
Requirements for this role include:
. 0 -1 year of experience in any Healthcare BPO
. University degree or equivalent that required 3+ years of formal studies
. 1+ year(s) of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools.
. Ability to work scheduled shifts from Monday-Friday 06:00 PM to 04:00 AM (weekend's if required) and to be flexible to accommodate extra hours due to business requirements
. Ability to communicate (oral/written) effectively in English to exchange information with our client.