Senior Representative - Insurance Operations null

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 Procedures.
• 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 team.
• 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
• Ability to work scheduled shifts from Monday-Friday7:30 AM to 5:30 PM (weekends 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 clients.