Job title: Claim Process Associate
Location: Airoli Knowledge Park-TTC Industrial Area, Villages Airoli and Dighe, Navi Mumbai Pin-400708.
(Candidate should be within 25KMS radius).
Work from Office (WFO)
Shift timing: 5:30 PM to 3 AM
2 way cab facility pick up & drop
Looking for only freshers graduates, who are available to join with in 15days
- Group Life Insurance products and processes experience (Mandatory)
- 0-6 months experience in Back Office deal (Essential)
- Strong knowledge of Group Insurance products (Disability, Absence and PFL) and service offerings (Mandatory)
- US Customer Service experience (Desirable)
- Disability Claims Examiner is responsible for the calculation of leaves, date and work schedule according to Plan Provisions
- High quality of work standards including strong attention to detail
- Gathers information and performs variety of complex or administrative support functions
- Strong knowledge on US Disability and Absence policies and procedures to optimize claimant benefits
- Escalates non-routine issues to SME/ Team Leads for problem resolution
- Efficiently and effectively manage an assigned caseload of disability claims and facilitate the technical aspect and appropriately apply the legal and contractual provisions
- Input claimant medical and demographic data, evaluate claimant eligibility and develop plan to address obstacles
- Adhere to federal and state regulatory and/or client plan requirements and established workflows including plan provisions
- Obtains information from claimant or other supporting systems, emails and/or from fax
- Collection of non-clinical information needed for review from claimants and providers from clinicals
- Interact with internal and external customers including, but not limited to, claimants, employers, physicians/ health care providers, attorneys etc. to gather the information needed to manage the claim
- Responsible for reporting known or suspected data disclosures or fraud on the day of discovery to a Team Lead
- Performs case checks and reviews to ensure case creation is complete and correct
- Understand and correctly utilize the appropriate systems