Process Associate

Process Associate/ Process Developer Health and Dental Insurance Claims

2yrs to 3yrs

Minimum qualifications

Any Graduate except Technical

Insurance domain certification will be an added advantage

Preferred qualifications

Claims processing knowledge with Insurance Domain awareness

Good Communication Skills

Good working knowledge of MS Office

Responsibilities

Transaction processing for Health and Dental Insurance Claims process

Transaction processing for Claims Support Teams.

Client interactions via training, conference calls, emails etc.

Manage MIS activities and data collation

Work towards driving process improvements and initiatives

Validating the medical records / invoices and reviewing the medical history

Manage all aspects of the claim process Adjudicate non-complex claims according to established guidelines and standards as well as state legislation Determine appropriate requirements Analyze and interpret claim documentation, policy contract wording and in-force policy documentation to establish whether the claim is complete and valid, correct death benefit and correct beneficiary Make claim decisions within approval limits Make disbursements on valid claims to the correct beneficiary for the correct claim amount Communicate and collaborate with the field and head office colleagues to provide the highest quality and service levels to customers Handle other issues or requirements related to the claim such as check stop pay and reissue Ability to adapt to changing regulatory requirements affecting claim practices and apply new approaches

Specifically, claims and endowments; annual due diligence address cleanse, process pre-escheatment claim payments Process accounting as required Assist in identifying and providing solutions to work related problems and issues (ie. work flow, systems) Communicate with claimants or their legal representatives as required Comply with complex state legislative requirements in terms of claims practices and report any fraudulent activities to the appropriate sources Comply with departmental procedures Actively participate in claims department projects that improve effectiveness and efficiency