Medical Claims Specialist | Foundever

Job description

JOB DESCRIPTION : This role involves delivering exceptional customer service, primarily through inbound calls, addressing inquiries about healthcare policy provisions from employer-provided plans. Outbound calls are also conducted as dictated by client-specific processes. Work-Life Balance: Enjoy a 5-day work week with 2 rotational days off Global Shift Alignment: Work primarily during US business hours "Night shift's". Hiring for Fresher's and Experienced (should possess exceptionally great communication skills in English) Skills & Knowledge Fluent in business English (written and spoken). Compensation & Perks: Free transportation service available for commutes within a 30km radius 2 Way Cab Facility (home pickup and home drop) Education High School Diploma or equivalent required or any degree preferred. Key Responsibilities Include: Information Delivery: • Review of the Family Medical Leave Act (FMLA), state, company, and other absence certifications as mandated by state and federal guidelines and in coordination with our customers policies • Provide accurate, professional, and timely responses to communications from internal and external partners • Contact medical providers to obtain or clarify medical facts supporting the need for a leave of absence • Maintain complete and accurate documentation of leaves within our proprietary database • Correspond with clients regarding leave status and assist with decision making • Process reports for clients and short-term disability partners • Input and analyses data • Demonstrate respect, sensitivity, and confidentiality, while always maintaining professionalism. • Meet and adhere to production and quality goals as well as performance metrics. • Responsible and accountable for maintaining and protecting personal, confidential claimant health information. Must maintain a high level of confidentiality and abide by HIPAA rules and regulations. • Engage in ongoing education and training around laws, policies and service delivery. • Support management with special projects as necessary • Other duties as assigned Professional Conduct: Performing all responsibilities consistently and professionally, utilizing strong verbal, interpersonal, and quality service skills. Multichannel Support: Handling inbound customer calls courteously, timely, and professionally, including managing inquiries via email and live chat. Active Listening & Problem Solving: Actively listening to customers, understanding their needs, and resolving issues effectively. Escalation Management: Escalating customer issues to appropriate staff and management for resolution as needed. First Call Resolution: Ensuring first call resolution through effective problem-solving and call handling. Process Adherence: Strictly following client program processes and performing all tasks courteously and professionally. Knowledge Utilization: Utilizing knowledge base resources and training to accurately answer customer questions. Record Keeping: Creating and maintaining accurate customer records with detailed call information. Documentation: Accurately documenting call resolutions in the appropriate systems. Financial Compliance: Strictly adhering to client processes for handling financial issues and inquiries. Confidentiality: Complying with all requirements concerning confidential and personal information. Policy Adherence: Following all required scripts, policies, and procedures. Schedule Compliance: Adhering to all attendance, work schedule, and scheduled training requirements. Rounds of Interview: HR Round Online Assessment Manual Voice Assessment Operational Round If you meet the above criteria and are eager to be part of a dynamic team, please send your resume via WhatsApp or call to this number Shravani: 9032470898