Claims Account Analyst is responsible for evaluating claims to ensure they are accurate and processed in a timely manner. They review and assess the validity of claims based on the policy guidelines. They also follow precise procedures in managing high-volume claims according to department goals and deadline.
Adjudicate and process claims based on appropriate client business rules, utilizing department software and resources, interact with internal and external customers in a positive and professional manner, follow precise procedures, prioritize, plan and manage claim volume based on department deadline goals, work independently while maintaining team cohesiveness, identify and effectively communicate system issues to ensure accurate and timely payment processing, review documents to ensure that all forms are accurate and complete
Key Accountabilities
- Evaluate all claims for accuracy and completeness of documentations.
- Review, Investigate and determine the validity of claims based on the policy guidelines.
- Process electronic spreadsheets and paper claims submitted by service network-providers in appropriate payment module.
- Adjudicate claims based on appropriate underwriter and client's specific business rules.
- Respond to claim inquiries from both customers and internal stakeholders.
- Resolve discrepancies or issues with claims.
- Raise system issues effectively to the proper department.
- Ensure shared mailbox is being managed well and queries are attended promptly.
- Issue clear, effective, and accurate communications to internal and external customers
- Conduct all interactions with internal and external customers in a positive and professional manner
- Report problems and provide alternate solutions to Supervisor
- Promotes customer satisfaction and quality customer service for internal clients.
- Looks for opportunities for continuous improvement in accounting processes and controls, willing to challenge the status quo.
- Performs ad hoc activities and tasks as required
Qualifications
Education:
Minimum Diploma in Accounting, Finance or related field (an equivalent combination of related education, training, and experience may be considered)
Experiences, Skillsets & Personal Competencies
Work Experiences:
- At least 2 years of relevant working experience
- Experience in processing high-volume of claims
Competencies:
- Ability to prioritize, plan and manage a high-volume workload
- Ability to work independently while maintaining team cohesiveness
- Must be flexible to adapt to changing situations in work responsibilities
- Ability to prioritize, plan and manage a high-volume workload.
- Ability to work independently while maintaining team cohesiveness.
- Must be flexible to adapt to changing situations in work responsibilities.
- Good oral and written communication skills.
- Strong Analytical Skills and excellent attention to details.
- Good computer skills including common business applications such as MS Windows and MS Office including Excel and Word.
- Positive, self-directed individual with a strong desire and ability to manage change and process improvement as the business grows.
- Advocates a culture of compliance with policies and controls.
- Good communicator and willing to build strong business relationships, able to work cross-functionally and cross-culturally.
- Must be able to work overtime when required.
- Able to work flexible hours as needed during peak times
