Position Overview
We are seeking aClaims Specialistto review, evaluate, and process medical form requests with accuracy and professionalism. The role requires handling of submission forms, complete followups via outbound calls, and ensure timely, highquality service to both internal and external stakeholders.
Key Responsibilities
- Review and process Notice and Proof forms in line with company policies, guidelines, and regulatory requirements.
- Enter medical provider information accurately into claims processing systems.
- Identify discrepancies or missing details and conduct followups with providers, employers, or claimants through outbound calls.
- Ensure timely closure (adjudication) of followups to meet productivity and quality targets.
- Document all claim actions clearly and accurately within internal systems.
- Prepare, review, and finalize written communication for medical providers and claimants as per policy standards.
- Collaborate with Quality Assurance, Customer Support, and Medical Review teams to resolve complex cases.
- Escalate highrisk or unusual cases to leadership or medical reviewers when necessary.
- Support continuous improvement by identifying trends, sharing feedback, and recommending process enhancements.
