9 Claims Operations Jobs

In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more experienced roles Interact with colleagues on basic day-to-day issues, and network with supporting functional areas to create a seamless experience for the customers Required Qualifications: 6+ months of customer service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education

About this role: Wells Fargo is seeking a Fraud & Claims Operations Representative. In this role, you will: Support fraud and claims functional area by proactively identifying opportunities to improve customer experience, and offer ideas to mitigate risks through effective authentication of customers in order to prevent fraudulent activity Perform moderately complex customer support tasks by utilizing solid communication, and verbal and written skills to establish rapport with customer and to deescalate difficult, as well as sensitive information as a part of resolving a claim Oversee multiple claim types, take appropriate action to decision the case using multiple systems and applications, and may contact third parties for research, as needed Receive direction from supervisor and escalate questions or issues Interact with immediate team and functional area on wider range of information, plus internal or external customers Required Qualifications: 1+ years of Customer Service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education Desired Qualifications: Should have knowledge in Debit Credit cards, Regulation E guidelines, US banking regulations. Ability to work additional hours if required. Must work on-site at the location posted. Must be flexible to work in multiple shifts Knowledge in Debit and Credit cards Strong analytical skills Good communication skills Job Expectations: Must be able to attend full duration of required training period Ability to work additional hours as needed Must work on-site at the location posted Shift Timing: 8:30 pm to 5:30 am IST (US Holiday)

About this role: Wells Fargo is seeking a Senior Fraud & Claims Operations Representative . In this role, you will: Support fraud and claims functional area by proactively identifying opportunities to improve customer experience, and offer ideas to mitigate risks through effective authentication of customers in order to detect and prevent fraudulent activity Perform complex customer support tasks by utilizing solid communication (inbound and outbound), verbal and written, skills to establish rapport with customer and to deescalate difficult, as well as sensitive information researched as a part of resolving a claim Oversee multiple claim types, take appropriate action to decision the case using multiple systems and applications, and may contact third parties for research, as needed Support team performance in identifying gaps in bank processes, procedures, customer, or colleague decisions Provide feedback and present ideas for improving or implementing processes and tools within fraud and claims functional area Provide subject matter knowledge and interpretation of procedures to less experienced staff Interact with fraud and claims functional area on a wide range of information as well as with external customers Required Qualifications: 18+ months of Customer Service, Financial Services, Fraud, or Investigations experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education Desired Qualifications: Experience in Quality Assurance process for Fraud & Claims Management. Should have wide knowledge in US banking regulations and guidelines. Should have knowledge on Debit/Credit cards, Fraudulent transactions, Risk monitoring. Advanced Microsoft Office skills. Ability to research and correspond with customers, probe with follow up questions respond to their concerns with detailed information. Ability to prioritize and meet deadlines. Good verbal, written, and interpersonal communication skills. Ability to compose clear, concise e-mails to a wide audience. Ability to navigate multiple computer systems, applications, and utilize search tools to find information. Excellent analytical skills with high attention to detail and accuracy. Ability to read correspondence accurately and be able to provide a written response. Ability to achieve high production and quality standards. Job Expectations: Must be able to attend full duration of required training period Ability to work additional hours as needed Must work on-site at the location posted Shift Timing: 8:30 pm to 5:30 am IST (US Holiday)

About this role: Wells Fargo is seeking an Associate Fraud & Claims Operations Representative. In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more experienced roles Interact with colleagues on basic day-to-day issues, and network with supporting functional areas to create a seamless experience for the customers Required Qualifications, 6+ months of customer service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education

About this role: Wells Fargo is seeking a Associate Fraud & Claims Operations Representative. In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more experienced roles Interact with colleagues on basic day-to-day issues, and network with supporting functional areas to create a seamless experience for the customers Required Qualifications: 6 months of customer service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education

In this role, you will: Support fraud and claims functional area by proactively identifying opportunities to improve customer experience, and offer ideas to mitigate risks through effective authentication of customers in order to prevent fraudulent activity Perform moderately complex customer support tasks by utilizing solid communication, and verbal and written skills to establish rapport with customer and to deescalate difficult, as well as sensitive information as a part of resolving a claim Oversee multiple claim types, take appropriate action to decision the case using multiple systems and applications, and may contact third parties for research, as needed Receive direction from supervisor and escalate questions or issues Interact with immediate team and functional area on wider range of information, plus internal or external customers Required Qualifications: 1+ years of Customer Service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education Job Expectations: Must be able to attend full duration of required training period Ability to work additional hours as needed Must work on-site at the location posted Must be flexible to work on weekends Must be flexible to work in multiple shifts

About this role: Wells Fargo is seeking an Associate Fraud & Claims Operations Representative In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more experienced roles Interact with colleagues on basic day-to-day issues, and network with supporting functional areas to create a seamless experience for the customers Required Qualifications: 6+ months of customer service experience, or equivalent demonstrated through one or a combination of the following: work experience, training, military experience, education

Provides clinical review expertise for high dollar and complex claims, including facility and professional bills. Provides cost containment services by identifying coding and billing errors and insuring application of Medical and Reimbursement Policies. Additionally identifies cases for potential fraud and abuse and makes referrals. Major Job Responsibilities Evaluates medical information against criteria, benefit plan, coverage policies and determines necessity for procedure and refers to Medical Director if criteria are not met Evaluate itemized bills against reimbursement policies Adheres to quality assurance standards Serves as a resource to facilitate understanding of products Handles some escalated cases; secures supervisory assistance with problem solving and decision making Advises supervisory staff of any concerns or complaints expressed by Health Care Professionals Utilizes effective communication, courtesy and professionalism in all interactions, both internally and externally Performs additional unit duties below as appropriate: Participate on special projects. Perform random or focused reviews as required. Support and assist with training and precepting as required Analyze clinical information Perform claim reviews with focus on coding and billing errors Identify and refer cases for possible fraud/abuse or questionable billing practices to the appropriate matrix partners Handle multiple products and benefit plans Works under moderate direct supervision. Qualifications MBBS. Maintain active Medical as required by state and company guidelines Clinical experience in hospital/clinic for 3 or more years Team player Flexible/Adaptable Excellent time management, organizational, and research skills Experience with MS Office Suite (Outlook, Excel, Access, SharePoint) Preferred Qualifications Utilization Review or Claim Review experience in Health insurance Knowledge of the Principles of Health Care Reimbursement Key Skills and Competencies Strong background in quantitative decision making, ability to drive business/operations metrics Metrics-driven. Able to translate strategy into measurable operational goals and objectives. Disciplined in assessing performance and addressing problems. Good communication and strong interpersonal skills. Highly organized, structured & proactive. Good inter-cultural skills & Exposure to global work environment. Good time management skills - meet tight timelines and manage ad hoc deliverables, if any.

Full Time Opportunity Location: Goa/Kolkata/Patna/Assam/Jharkhand/Jamshedpur Job Description: - As a claim processing executive you will be responsible for handling all claim related activities on day today basis. - Checking all documents submitted by customers. - Verification of all documents with doctors, hospitals to cross check them for further process. - Coordination with customer if any document is missing or fake. Mentioning remark on every documents. - Coordination with head office to submit claim reports. - Coordination with branch head and other managers for smooth work process. - Maintaining MIS report on daily basis Qualification : MBBS, BAMS, BHMS Experience : 2 to 10 years in health insurance claim processing.