Job Description

Claims Processing: Receive, review, assess and calculate claims in accordance with policy requirements.

Document Verification: Analyze claim documentation, ensuring completeness and accuracy before processing payments.

Customer Engagement: Communicate with customers and other stakeholders to provide updates on claim statuses and requirements.

Regulatory Compliance: Ensure all claims adhere to internal policies, regulatory requirements, and industry best practices.

Risk Management: Assess potential risks in claims processing, implement strategies to mitigate financial and reputational risks, and ensure early detection of fraudulent claims.

Reporting: Prepare and maintain accurate claim records and reports for management review.

Process Improvement: Recommend and implement improvements to claims procedures to enhance efficiency and customer satisfaction.

Any other duties assigned from time to time

Provides a positive customer experience by being helpful and sensitive to customer needs, managing expectations and providing solutions including directing customers to the correct channel in adherence to procedural, productivity and quality standards. Provides specialist product and service knowledge that may lead to sales generation.

Responsibilities

Product/Service Information

Provide advanced product/service information and respond to basic customer questions about the product/service.

Customer Order Processing

Record and process custom/special customer orders, often dealing with ambiguous delivery expectations.

Resolving Customer Issues

Respond to basic issue escalations promptly and appropriately; provide managerial approvals as required.

Customer Relationship Development / Prospecting

Make calls (by telephone or in person) to allocated customers to develop new relationships. Act as a first point of contact for resolving customer queries and complaints.

Customer Relationship Management (CRM) Data

Schedule follow-up actions and enter relevant information into the CRM system after each contact with a customer to create a call plan and to ensure that the organization has quality data to enable effective customer retention and business development activities.

Customer Needs Clarification

Interview the customer, following a complex multilevel sales script, to clarify the customer’s requirements, or assist in conducting interviews with potential customers, making detailed notes to collect client requirements.

Renewals

Provide exceptional service to customers to encourage continued use of the organization’s products/services.

• Receive, review, assess and calculate claims in accordance with policy requirements.
• Analyze claim documentation, ensuring completeness and accuracy before processing payments.
• Communicate with customers and other stakeholders to provide updates on claim statuses and requirements.
• Ensure all claims adhere to internal policies, regulatory requirements, and industry best practices.
• Assess potential risks in claims processing, implement strategies to mitigate financial and reputational risks, and ensure early detection of fraudulent claims.
• Prepare and maintain accurate claim records and reports for management review.
• Recommend and implement improvements to claims procedures to enhance efficiency and customer satisfaction.
• Provide advanced product/service information and respond to basic customer questions about the product/service.
• Record and process custom/special customer orders, often dealing with ambiguous delivery expectations.
• Respond to basic issue escalations promptly and appropriately; provide managerial approvals as required.
• Make calls (by telephone or in person) to allocated customers to develop new relationships. Act as a first point of contact for resolving customer queries and complaints.
• Schedule follow-up actions and enter relevant information into the CRM system after each contact with a customer to create a call plan and to ensure that the organization has quality data to enable effective customer retention and business development activities.
• Interview the customer, following a complex multilevel sales script, to clarify the customer’s requirements, or assist in conducting interviews with potential customers, making detailed notes to collect client requirements.
• Provide exceptional service to customers to encourage continued use of the organization’s products/services.