730 Claims Processing Jobs - Page 25

Venue Walk-In Interview on 30-May-2025, Registration will End by 11:00AM Responsibilities: Applying medical knowledge in evaluating the medical claim files to ascertain the medical admissibility. Must understand the policy wordings including Terms & conditions to adjudicate the Admissibility/Rejection. Processing of claims as per regulatory guidelines. Adhering to the TATs in processing. Quality review of processed files. Grievance redressal, handling escalations and Identifying the fraudulent claims. Required understanding and evaluation criteria: Qualified MBBS, BAMS, BHMS having all certificates in hand Preferably from Insurance and TPA experience Clinical Acumen/knowledge in terms of hospital and medical procedures Understanding of Treatment Protocol Understanding of Diagnostic Protocol Ready to work from Office, No Work from Home, open on rotational shifts/ rotational week offs Office Address: Tata AIG GIC Limited, C/o Imperial Towers, Floor-5, Landmark - Next to Metro (Ameerpet) Station, Ameerpet, Hyderabad, Telangana (State)

To contact the insured for Underwriting referred proposals to procure the complete medical history using Audio and/or Video tools. To Follow up with customer for past medical records and/or relevant health documents Maintain end to end TAT / SLAs. Required Candidate profile Location – Bangalore Candidate must know to speak Hindi & Malayalam. CTC – Upto 3.5 LPA.

Job Title : Analyst Qualification : Any Graduate Experience : Fresher Must Have Skills : > Good working knowledge of the Microsoft office, particularly Excel & PowerPoint > Relevant Claims/risk management/Accounting Knowledge experience as a minimum according to the role Good to Have Skills : l Excellent analytical problem-solving skills. l Strong communication skills, both orally and in writing. l Commercial awareness a commercial and pragmatic approach to managing compliance. l IT literate knowledge of Microsoft office packages needed. Roles and Responsibilities : Accounts: l Good understanding of financial statements and accounting concepts l Strong analytical skills l Excellent knowledge of Microsoft office is essential and advanced Excel skills l Maintain and manage carrier accounts and settlements l Perform financial analysis and reporting Risk managements: l Collaborate with various teams for performing day-to-day activities ensuring effective risk management: l Engage with different departments to integrate risk management practices into their daily operations. l Identify potential risks and develop strategies to mitigate them in collaboration with cross-functional teams. l Ensure that risk management policies are consistently applied and adhered to across the organization. Claims: l Adjudicate international claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals. l Respond within the time commitment given to enquiries regarding plan design, eligibility, claims status and perform necessary action as required, with first issue/call resolution where possible. l Handling and resolving complex claim issues l Collaborating with internal teams to ensure accurate claims processing l Providing support in claims settlement negotiations l Maintaining detailed documentation of claims activities Location : Bangalore CTC Range : 3.7 lpa (lakh per annum) Notice period : Immediate Shift Timings : Early morning / Afternoon shift Mode of Interview : Virtual Mode of Work : Hybrid Mode of Hire : Permanent Note : NA -- Thanks & Regards, Tanishaa.S Staffing Analyst Black and White Business Solutions Pvt Ltd Bangalore,Karnataka,INDIA. Direct Number: 7899490271 Tanishaa.S@blackwhite.in | www.blackwhite.in

Job Title : Analyst Qualification : Any Graduate Experience : Fresher Must Have Skills : > Good working knowledge of the Microsoft office, particularly Excel & PowerPoint > Relevant Claims/risk management/Accounting Knowledge experience as a minimum according to the role Good to Have Skills : l Excellent analytical problem-solving skills. l Strong communication skills, both orally and in writing. l Commercial awareness a commercial and pragmatic approach to managing compliance. l IT literate knowledge of Microsoft office packages needed. Roles and Responsibilities : Accounts: l Good understanding of financial statements and accounting concepts l Strong analytical skills l Excellent knowledge of Microsoft office is essential and advanced Excel skills l Maintain and manage carrier accounts and settlements l Perform financial analysis and reporting Risk managements: l Collaborate with various teams for performing day-to-day activities ensuring effective risk management: l Engage with different departments to integrate risk management practices into their daily operations. l Identify potential risks and develop strategies to mitigate them in collaboration with cross-functional teams. l Ensure that risk management policies are consistently applied and adhered to across the organization. Claims: l Adjudicate international claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals. l Respond within the time commitment given to enquiries regarding plan design, eligibility, claims status and perform necessary action as required, with first issue/call resolution where possible. l Handling and resolving complex claim issues l Collaborating with internal teams to ensure accurate claims processing l Providing support in claims settlement negotiations l Maintaining detailed documentation of claims activities Location : Bangalore CTC Range : 3.7 lpa (lakh per annum) Notice period : Immediate Shift Timings : Early morning / Afternoon shift Mode of Interview : Virtual Mode of Work : Hybrid Mode of Hire : Permanent Note : NA -- Thanks & Regards, HR Janhavi Staffing Analyst Black and White Business Solutions Pvt Ltd Bangalore,Karnataka,INDIA. Direct Number: 8067432471| janhavi@blackwhite.in | www.blackwhite.in

Job Title : Analyst Qualification : Any Graduate Experience : Fresher Must Have Skills : > Good working knowledge of the Microsoft office, particularly Excel & PowerPoint > Relevant Claims/risk management/Accounting Knowledge experience as a minimum according to the role Good to Have Skills : l Excellent analytical problem-solving skills. l Strong communication skills, both orally and in writing. l Commercial awareness a commercial and pragmatic approach to managing compliance. l IT literate knowledge of Microsoft office packages needed. Roles and Responsibilities : Accounts: l Good understanding of financial statements and accounting concepts l Strong analytical skills l Excellent knowledge of Microsoft office is essential and advanced Excel skills l Maintain and manage carrier accounts and settlements l Perform financial analysis and reporting Risk managements: l Collaborate with various teams for performing day-to-day activities ensuring effective risk management: l Engage with different departments to integrate risk management practices into their daily operations. l Identify potential risks and develop strategies to mitigate them in collaboration with cross-functional teams. l Ensure that risk management policies are consistently applied and adhered to across the organization. Claims: l Adjudicate international claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals. l Respond within the time commitment given to enquiries regarding plan design, eligibility, claims status and perform necessary action as required, with first issue/call resolution where possible. l Handling and resolving complex claim issues l Collaborating with internal teams to ensure accurate claims processing l Providing support in claims settlement negotiations l Maintaining detailed documentation of claims activities Location : Bangalore CTC Range : 3.7 lpa (lakh per annum) Notice period : Immediate Shift Timings : Early morning / Afternoon shift Mode of Interview : Virtual Mode of Work : Hybrid Mode of Hire : Permanent Note : NA -- Thanks & Regards, HR Deekshitha Staffing Analyst Black and White Business Solutions Pvt Ltd Bangalore,Karnataka,INDIA. Direct Number: 8067432407| deekshitha@blackwhite.in | www.blackwhite.in

Job Title : Analyst Qualification : Any Graduate Experience : Fresher Must Have Skills : > Good working knowledge of the Microsoft office, particularly Excel & PowerPoint > Relevant Claims/risk management/Accounting Knowledge experience as a minimum according to the role Good to Have Skills : l Excellent analytical problem-solving skills. l Strong communication skills, both orally and in writing. l Commercial awareness a commercial and pragmatic approach to managing compliance. l IT literate knowledge of Microsoft office packages needed. Roles and Responsibilities : Accounts: l Good understanding of financial statements and accounting concepts l Strong analytical skills l Excellent knowledge of Microsoft office is essential and advanced Excel skills l Maintain and manage carrier accounts and settlements l Perform financial analysis and reporting Risk managements: l Collaborate with various teams for performing day-to-day activities ensuring effective risk management: l Engage with different departments to integrate risk management practices into their daily operations. l Identify potential risks and develop strategies to mitigate them in collaboration with cross-functional teams. l Ensure that risk management policies are consistently applied and adhered to across the organization. Claims: l Adjudicate international claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals. l Respond within the time commitment given to enquiries regarding plan design, eligibility, claims status and perform necessary action as required, with first issue/call resolution where possible. l Handling and resolving complex claim issues l Collaborating with internal teams to ensure accurate claims processing l Providing support in claims settlement negotiations l Maintaining detailed documentation of claims activities Location : Bangalore CTC Range : 3.7 lpa (lakh per annum) Notice period : Immediate Shift Timings : Early morning / Afternoon shift Mode of Interview : Virtual Mode of Work : Hybrid Mode of Hire : Permanent Note : NA HR Sanjana Staffing Analyst Black and White Business Solutions Pvt Ltd Bangalore,Karnataka,INDIA. Direct Number: 8067432404| sanjana.b@blackwhite.in | www.blackwhite.in

Job Title : Marine | End-to-end Claims Insurance Qualification : Any Graduate and Above Relevant Experience : 3 7 years Must Have Skills : 1.Insurance regulations and laws 2.Claims handling procedures 3.Risk management principles 4.Industry standards 5.Maritime law and regulations 6.Investigate and analyze claims documentation 7.Determine coverage and liability 8.Negotiate settlements and resolve disputes 9.Communicate effectively with insureds, claimants, suppliers and brokers 10.Apply industry-standard claims handling procedures. 11.Collaboration and teamwork Good Have Skills : Experience in Marine Adjuster Roles and Responsibilities : 1.Investigate the circumstances surrounding marine incidents, such as collisions, groundings, or cargo damage. 2.Assess the extent of damage to vessels, cargo, or freight, and estimate the cost of repairs or replacement. 3.Appropriately document information on claim file Maintain effective and ongoing communication with various internal and external contact. 4.Learn and follow best practices of clients as well as claims requirements, standards and practices as required by applicable state statutes. 5.Ensure compliance with relevant maritime law and regulations Ensure adherence to regulatory requirements, industry standards, and company policies. 6.Mitigate organizational risk, maintaining compliance and reputation Location : Kochi, Pune CTC Range : 4.5 7.5 LPA (Lakhs Per Annum) Notice Period : Immediate Mode of Interview : Virtual Shift Timing : Night Shift Mode of Work : Hybrid Thanks & Regards, Amulya G Senior HR Analyst Black and White Business Solutions Pvt Ltd Bangalore, Karnataka, INDIA. Direct Number: 080-67432435/Whatsapp @6366979339 amulya.g@blackwhite.in | www.blackwhite.in ****************************** DO REFER YOUR FRIENDS**********************************

Role: Senior Manager/Manager - Health Claims (Claims Processing) Job location: Goregaon East Role & responsibilities Experience: 2+ years (preferably with Insurer/TPA) Key Responsibilities: Process and review health insurance claims in line with policy and regulatory guidelines. Verify clinical documents (discharge summaries, prescriptions, medical reports) for claim validation. Coordinate with TPAs, brokers, and clients for claim-related queries and document collection. Manage client escalations related to claim disputes or delays. Review and reject claims where necessary, providing clear reasons and communication Ensure compliance with health insurance regulations and company policies. Prepare reports on claim processing status and outcomes. Suggest process improvements to enhance efficiency and accuracy. Qualifications & Skills: Degree in BAMS, BHMS, MBBS, or Dentistry. Minimum 2 years experience in health claims processing with insurers or TPAs. Good understanding of insurance products, claims procedures, and regulatory requirements. Strong analytical, communication, and coordination skills. Proficient with MS Office and claims management tools. Ability to handle multiple tasks and client interactions effectively.

Job Title: Director /Sr Director - RCM Operations END TO END Location: Chennai & Bangalore Preferred candidate profile -RCM END TO END AR Job Title: Director /Sr Director - Coding Director Location: Chennai & Bangalore Preferred candidate profile: Handling medical coding Team - 20+ years of experience in the RCM (Revenue Cycle Management) industry with a minimum 10+ years of experience working on various leadership roles. - Should have experience in managing multiple processes with a strength of at least 800+ employees. Job Description Director of Operations Responsibilities: Manage RCM teams across all areas claim scrubbing, charge submission, payment posting, denial management and account receivables. Responsibilities include work allocation, capacity planning, training and development, performance evaluation, problem resolution. Deliver best in class KPIs on charge lag, Days in AR, 90% + AR, Denials, Collections for the clients managed. Analyze claims data to come up with actionable insights to send out clean claims, increase collections and minimize account receivables. Provide leadership and guidance to develop team members to perform at high levels of performance standards both in terms of quality and productivity. Serve as “in-house” subject matter expert for all billing and collections processes and queries. Build strong relationship and collaborate with US based teams. Ensures compliance with billing guidelines, data / privacy requirements, etc. Identifies and collaborates with other key stakeholders on automation, analytics and transformation initiatives. Requirements: Director Operations RCM Minimum of 20 years of experience with minimum of 10 years in medical billing / collections area. 5+ years of experience in executive leadership role. Strong subject matter experience Revenue Cycle Management: certification in medical billing / coding preferred. Proficient in multiple EMR systems, MS Excel, PowerPoint and Word. Strong leadership, team development and coaching skills. Excellent communication, problem solving and analytical skills. Willingness to work flexibly in a fast-paced environment. Experience in driving transformation and automation will be an added advantage. Perks and benefits Best in industry Share Resumes to Ahmed@talentqs.com Whatsapp cV - 9246192522

Hiring for AR Caller - Medical billing Job Location: Mohali/ Chandigarh Salary Range: 18000-20000 Qualification: 12th+6 Months experienced with letter Graduate fresher can also apply 5 Days working with Night Shift Cab facility available Required Candidate profile Can Contact@ 7696111291

We are looking for Dynamic Candidate with good Communication Skill Roles and Responsibilities Greeting and welcoming passengers, and responding to questions. Checking in baggage. Making reservations. Selling airline tickets. Stocking aircraft with refreshments. Cleaning aircraft after flights. Assisting disabled passengers and those with small children. Providing information to passengers.

We are looking for Dynamic Candidate with good Communication Skill Roles and Responsibilities Greeting and welcoming passengers, and responding to questions. Checking in baggage. Making reservations. Selling airline tickets. Stocking aircraft with refreshments. Cleaning aircraft after flights. Assisting disabled passengers and those with small children. Providing information to passengers.

We are looking for Dynamic Candidate with good Communication Skill Roles and Responsibilities Greeting and welcoming passengers, and responding to questions. Checking in baggage. Making reservations. Selling airline tickets. Stocking aircraft with refreshments. Cleaning aircraft after flights. Assisting disabled passengers and those with small children. Providing information to passengers.

We are looking for Dynamic Candidate with good Communication Skill Roles and Responsibilities Greeting and welcoming passengers, and responding to questions. Checking in baggage. Making reservations. Selling airline tickets. Stocking aircraft with refreshments. Cleaning aircraft after flights. Assisting disabled passengers and those with small children. Providing information to passengers.

Dear Candidate, We are looking for Dynamic Candidate with good Communication Skill Roles and Responsibilities Greeting and welcoming passengers, and responding to questions. Checking in baggage. Making reservations. Selling airline tickets. Stocking aircraft with refreshments. Cleaning aircraft after flights. Assisting disabled passengers and those with small children. Providing information to passengers.

Dear Candidate, We are looking for Dynamic Candidate with good Communication Skill Roles and Responsibilities Greeting and welcoming passengers, and responding to questions. Checking in baggage. Making reservations. Selling airline tickets. Stocking aircraft with refreshments. Cleaning aircraft after flights. Assisting disabled passengers and those with small children. Providing information to passengers.

Handle Motor third party claims for particular states. Review investigation reports Drive TP claim settlement before Courts / Lok Adalat Interact with External Counsels to brief them to present the Company s defence effectively before the Courts. Review the performance of Advocates. Conduct periodic review and monitor the claims. Work out a litigation strategy for the regions handled to enable proper decision making. Review of high value TP claims handled for reserve adequacy and effective defence Candidate must have: - Strong communication & coordination skills - Ability to engage with External Advocates & stakeholders within the Company - in-depth market knowledge w.r.t. Court procedures and local practices - Ability & passion to drive the performance to achieve the set objectives - Analytical mindset - Need to know local language Hindi & English - Conversant with system MS Office

Responsible for ensuring the nurse training and educational and educational programs of the hospital are in line with the hospitals mission, vision and values of the institution. Develops an environment of learning for nurses in the hospital; Facilitate adult learning in the hospital by planning, identifying the needs. Responsible for identifying the changes in the nursing practice using an evidence based approach and facilitating the initiation of, adoption of, and adaptation to change. Facilitates the new learning in implementation the same in nursing practice. Responsible for designing, creating and applying research by supporting the integration of research into practice and helping to develop staff members knowledge and skills in the research process, as well as fostering the use of systematic evaluative research with regard to clinical, educational data. Responsible for enhancing the clinical competence all across the hospital. Responsible for providing ongoing evaluation of the quality and effectiveness of the educational activities to ensure that they maintain and enhance professional development that promotes the delivery of cost-effective high quality healthcare. Collaborating with the others in the practices of nursing professional development at the institutional, local, regional, and state levels.

Job Description: Our client, a leading AI platform specializing in medical billing operations, is seeking dedicated and detail-oriented Medical Billing and Insurance Claims Specialists to join our team. The ideal candidates will have at least 6 months to 1 year of experience in medical billing, insurance claims, or a related field and possess strong English proficiency . As part of our client-facing team, you will be providing vital support to client operations by ensuring accurate and compliant medical billing operations through outbound calling, data categorization, and transcript analysis. Key Responsibilities: Outbound Calling: Make outbound calls to insurance companies and payors to collect essential information, including claim statuses, denial reasons, and any additional relevant details. Conduct all calls in full compliance with company's guidelines and applicable healthcare regulations. Maintain professionalism and ensure clear communication during each call. Data Categorization and Labeling: Accurately record, categorize, and label calls or information gathered using the taxonomy and definitions provided by the client. Ensure all claim statuses and call outcomes are properly labeled for consistency in reporting and easy analysis. Deliver categorized data in periodic reports or through the portal developed by client, following the requested format and frequency. Call Transcript Analysis: Analyze recorded call transcripts to extract actionable insights, identifying trends, recurring denial reasons, and other patterns. Compile findings into periodic reports, providing valuable information to client to support process improvements and optimize workflows. Qualifications: Minimum of 6 months to 1 year of experience in medical billing, insurance claims, or a related field. Strong English proficiency , both verbal and written. Familiarity with healthcare regulations and industry guidelines. Excellent communication skills with the ability to make outbound calls to insurance companies and payors. Detail-oriented and able to maintain accurate records. Ability to work independently while adhering to internal guidelines and procedures. Proficiency in Microsoft Office Suite or similar software; experience with medical billing software is a plus. Additional Information: This is a full-time position, and the successful candidate will work closely with the clients team to support their AI-powered platform in improving medical billing operations. The role offers an opportunity for professional growth and development within a dynamic, technology-driven environment.

Service Experience Lead, Assurant-India(digital & non digital) This position is responsible for the delivery of exceptional customer service through claims review as per SLA. This position will be Work from the Office at our Mumbai, India location. What will be my duties and responsibilities in this job? • Adjudicate each claim with available details of defect & estimates. Collect, verify and analyze information obtained during the claims process used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures, • Ensure Service partners work as per agreed SLAs to meet service standards. • Create monthly claims reports • Claim cost reduction plans and actions. • Demonstrate flexibility, enthusiasm and strong learning agility in learning new products, systems and processes while maintaining high customer service and compliance standards. What are the requirements needed for this position? • Graduate in any stream • Min 5 years of experience of working in Service Operations.

An excellent opportunity for a seasoned operation professional to lead and manage high-performing teams in motor insurance claims. This role offers exposure to end-to-end claims operations, client interactions, and team leadership in a process excellence-driven environment. Your Future Employer - A leading global business process management company serving clients across industries like Insurance, Banking, Travel, Healthcare, and more. With a strong focus on innovation, analytics, and digital transformation, the organization enables businesses to achieve superior operational outcomes and efficiency. Responsibilities - Managing day-to-day operations and driving performance improvements across functions. Overseeing the motor bodily injury claims process with a focus on compliance and timely resolution. Leading and mentoring a team to foster engagement and accountability. Collaborating with legal and external stakeholders on complex claims. Monitoring KPIs, identifying process gaps, and driving continuous improvement initiatives. Ensuring compliance with industry regulations and internal controls. Driving automation initiatives and contributing to digital transformation efforts. Requirements - Graduate degree in Business Administration, Insurance, or a related field. Strong experience in operations management, especially in the insurance sector. Proven track record in managing motor insurance claims and leading large teams. Excellent communication, analytical, and stakeholder management skills. Familiarity with claims systems, risk assessment methodologies, and process optimization tools. What is in it for you - Opportunity to drive operational excellence and team performance. Exposure to global best practices in insurance operations. Be a key contributor to digital transformation and strategic projects. Reach us: If you think this role aligns with your career goals, please email your updated resume to vasu.joshi@crescendogroup.in for a confidential discussion. Disclaimer: Crescendo Global specializes in Senior to C-level niche recruitment. We are committed to enabling job seekers and employers with an engaging and professional recruitment experience. Crescendo Global does not discriminate on the basis of race, religion, gender, sexual orientation, age, disability, or any other protected status. Note: Due to the volume of applications we receive, we may only respond to shortlisted candidates. Thank you for your understanding. Scam Alert: Beware of fraudulent job offers in the name of Crescendo Global. We do not charge fees or request purchases. All valid opportunities are listed at www.crescendo-global.com. Profile Keywords - Deputy Manager Jobs, Operations Jobs, Insurance Claims Jobs, Motor Insurance, Claims Management, SLA Management, Team Leadership, Client Management, Operations Excellence, BPM Jobs, Insurance Operations, Claims Processing.

Job description Experience Required 4+ years (Property and Casualty domain is mandatory) Notice Period Immediate to 30 days Shift Timings 630 PM to 330 AM IST (US Shifts) Role Overview We are looking for an experienced Property and Casualty Claims Specialist to support claims processing and management in the US insurance process. The candidate will focus on evaluating and processing claims while ensuring compliance with industry standards. Key Responsibilities Review and process insurance claims and related documentation. Conduct claims assessments, ensuring accuracy and completeness. Coordinate with brokers and carriers to gather necessary information. Prepare claims reports and ensure timely follow-up on pending claims. Maintain accurate records in claims management systems. Ensure compliance with industry regulations and internal guidelines. Collaborate with team members to resolve claim issues and provide necessary support. Qualifications Bachelors degree in any field. 5+ years of experience in Property and Casualty claims processing, with exposure to the US insurance market. Strong analytical, organizational, and problem-solving skills. Excellent communication and customer service skills. Proficiency in claims management software and tools.

Key Responsibilities: - Installation and SetupAssist in the installation, setup, and configuration of medical devices at customer sites, ensuring proper integration and functionality. - Preventive MaintenancePerform routine maintenance tasks on medical devices according to manufacturer guidelines, including cleaning, calibration, and testing. - Troubleshooting and RepairsDiagnose technical issues with medical devices, identify root causes, and implement timely repairs to minimize downtime. - Quality AssuranceConduct inspections and quality checks on medical devices to verify compliance with regulatory standards and company specifications. - User TrainingProvide training and technical support to healthcare professionals on the proper use and maintenance of medical devices. - DocumentationMaintain accurate records of equipment maintenance, repairs, and service activities, ensuring compliance with regulatory requirements. - Customer SupportRespond to customer inquiries and service requests in a timely and professional manner, providing effective solutions and recommendations. - Should be open to travel when it is troubleshooting/handholding of devices Qualifications: - Associate degree or certification in biomedical equipment technology, electronics, or a related field. - Previous experience in medical device installation, maintenance, or repair is preferred. - Strong technical aptitude and problem-solving skills, with the ability to troubleshoot complex equipment issues. - Excellent communication and interpersonal skills, with the ability to interact effectively with customers and internal teams. - Detail-oriented approach with a commitment to quality assurance and customer satisfaction. - Ability to work independently and prioritize tasks in a dynamic and fast-paced environment This job opening was posted long time back. It may not be active. Nor was it removed by the recruiter. Please use your discretion.

Position Manager Qualification Any graduation Experience 10 years of BPO experience in US Healthcare domain Job Location Coimbatore, WFO Salary 10-12 Lakhs per annum

Long Term Disability Claim Manager Role Overview: The LTD Claim Manager will manage an assigned caseload of Long-Term Disability cases. This includes management of claims with longer duration and evolving medical conditions. LTD Claim Managers will have meaningful and transparent conversations with their customers and clinical partners in order to gather the information that is most relevant to each claim. It also requires potentially complex benefit calculations on a monthly basis. The candidate will also evaluate customer eligibility and interact with internal and external customers including, but not limited to, customers, employers, physicians, internal business matrix partners and attorneys etc. to gather the information to make the decision on the claim. What You'll Do: Proactively manage your block of claims by regularly talking with and knowing your customers, their level of functioning, and having a command of case facts for each claim in your block Develop and document Strategic Case Plans that focus on the future direction of the claim using a holistic viewpoint Find customer eligibility by reviewing contractual language and medical documentation, interpret information and make decisions based on facts presented Leverage claim dashboard to manage claim inventory to find which claims to focus efforts on for maximum impact Have discussions with customers and employers regarding return to work opportunities and communicate with an action-oriented approach. Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis Ask focused questions of internal resources (e.g. nurse, behavioral, doctor, vocational) and external resources (customer, employer, treating provider) in order to question discrepancies, close gaps and clarify inconsistencies Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information Execute on all client performance guarantees Respond to all communications within customer service protocols in a clear, concise and timely manner Make fair, accurate, timely, and quality claim decisions Adhere to standard timeframes for processing mail, tasks and outliers Support and promote all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.) Clearly articulate claim decisions both verbally and in written communications Understand Corporate Compliance, Policies and Procedures and best practices Stay abreast of ongoing trainings associated with role and business unit objectives What You'll Bring: High School Diploma or GED required. Bachelor's degree strongly preferred. Long Term Disability Claims experience preferred. Experience in hospital administration, medical office management, financial services and/ or business operations is a (+) Comfortable talking with customers and having thorough phone conversations. Excellent organizational and time management skills. Strong critical thinker. Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously. Ability to focus and excel at quality production Proficiency with MS Office applications is required (Word, Outlook, Excel). Strong written and verbal skills demonstrated in previous work experience. Specific experience with collaborative negotiations. Proven skills in positive and effective interaction with customers. Experience in effectively meeting/exceeding personal professional expectations and team goals. Must have the ability to work with a sense of urgency and be a self-starter with a customer focus mindset. Comfortable giving and receiving feedback. Flexible to change. Demonstrated analytical and math skills. Critical Competencies: Decision Quality Communicate Effectively Action Oriented Manages Ambiguity Customer Focus