YOUR JOB

• As Claims Representative you analyze claims in respect of client medical costs.
• You adjudicate medical/dental and vision claims in accordance with policy terms and conditions to meet personal and team productivity and quality goals.
• You analyze reimbursements according to the contract agreements and assess, code and calculate them using a computerized claims processing system.
• You pass communications to the communication team to solve or preempt any possible issues with your stakeholders.
• Monitor turnaround times to ensure your claims are settled within required time scales, highlighting to your supervisor when this is not achievable.
• You take responsibility/ownership of complex cases. You handle them accurately and with the personal attention that is required.
• You keep your knowledge up to date with respect to the medical information necessary for handling claims and you take part in trainings to ensure you are up to date with policies, processes and other required information.
• You are attentive to inaccuracies in the files and communicate them to your team leader/departmental head.
• Respond within the time commitment given to enquiries regarding plan design, eligibility, claims status and perform necessary action as required, with first call resolution where possible.
• Carry out other adhoc tasks as required in meeting business needs.

YOUR PROFILE

• You have an active knowledge of English which you are not afraid to use in interactions with both internal and external parties. knowledge of French language is an added advantage.
• You are prompt, precise and good with numbers.
• A first experience in analytical work is a plus
• You have an eye for detail and you are known to work meticulously.
• You can work individually and make correct decisions, always keeping customer centricity as guiding principle through everyday work;
• You are flexible and quickly adapt to ever-changing work processes.
• You are aware of the sensitivity and delicacy of the information you handle.
• You are proactive, ensuring a smooth workflow and taking into account the needs of your client.
• You are a team-player, sharing best practices on processes and procedures with your colleagues.
• You can familiarize yourself quickly with computer applications.
• Diploma or degree in a related field.