CLAIMS ADJUSTMENT SPECIALIST

Job Description : CLAIMS ADJUSTMENT SPECIALIST

Responsibilities:

The Claim Adjustment Specialist is responsible for end-to-end validation, reviewing and responding to all requests and questions with respect to Risk Management-related issues which include workers compensation claims. Provide direct assistance on all claim-related questions or requests. Take ownership of the question or request and ensure the question or request is properly handled or documented.

• Coordinate with TPA on claim issues and concerns while providing claim oversight.
• Accurately document claim activities and maintain up to date records in claim management system.
• Review claim forms, supporting documents and customer information.
• Validate claim eligibility based on policy coverage, limits and conditions.
• Identify discrepancies, missing information or fraud indicators.
• Meet TAT, accuracy and SLA targets.

Skills Required:

• Strong Analytical skills and attention to detail
• Attention to detail
• Excellent Communication skills

Preferred Experience:

• 1-2 years of experience in Claims Management or Claims processing is mandatory