Process Associate

Job Description

You are as unique as your background, experience and point of view. Here, you ll be encouraged, empowered and challenged to be your best self. Youll work with dynamic colleagues - experts in their fields - who are eager to share their knowledge with you. Your leaders will inspire and help you reach your potential and soar to new heights. Every day, youll have new and exciting opportunities to make life brighter for our Clients - who are at the heart of everything we do. Discover how you can make a difference in the lives of individuals, families and communities around the world.Job description Person would be responsible to assess claims for benefit entitlement by reviewing contractual, medical, functional and occupational information - Sources include, but are not limited to, Independent Medical Evaluations, Functional Capacity Evaluations, Ergonomic assessments, medical consultant opinions, Rehabilitation Consultant resources, and consulting Mental Health Experts

• He / She will also be responsible for communicating with Disability Claims management team for follow up or escalations as per business requirements.
• Review claims and make final determinations for admittance or denial. Approve payment of claims and Company liability within established limits.
• Set claim action plan to ensure that determinations are adjudicated in a timely, accurate, and efficient manner

Preferred skills

• Good written and verbal communication skills Ability to understand conventional English business letters is critical
• Good mathematical aptitude and attention to detail
• Good commitment to customer service and quality
• Solid teamwork skills with the ability to work autonomously
• Good research and follow-up skills

Qualifications

• Minimum Graduate
• 1-4 years of Disability process experience in International BPOs (non-voice)
• Candidates to have worked in a previous North American Insurance company with Disability experience

Responsibilities

• Processes Disability requests in a timely and accurate manner
• Responsible for managing disability claims to resolution in a proactive manner. This includes determining if insured employees are eligible for disability benefits through to implementing the right interventions to support recovery and return to work for approved claims as early as it is safe to do so.
• Assess claims for benefit entitlement by reviewing contractual, medical, functional and occupational information - Sources include, but are not limited to, Independent Medical Evaluations, Functional Capacity Evaluations, Ergonomic assessments, medical consultant opinions, Rehabilitation Consultant resources, and consulting Mental Health Experts
• Meeting and exceeding client defined service level metrics on timeliness and accuracy
• Knowledge about Disability ICD codes & Medical Summary
• Communicates with customers through written and oral correspondence
• Provides follow up on requests that cannot be immediately resolved
• Builds relationships with staff from other departments to ensure queries are responded to in a timely manner
• Escalates issues to management when needed
• Works with management to set daily priorities to ensure prompt and efficient service
• Maintains flexibility in a high speed, demanding team environment
• Identifies process improvements to increase efficiencies and streamline processes
• Actively participates in departmental team meetings and other open forums
• Assists with department projects and initiatives as needed
• Soliciting and compiling information and data related to processing activities
• Using PC application and functions such as MS Excel and MS Word to update and load data sets
• Creating and monitoring the processing checklists and calendars

Job Category:Customer Service / OperationsPosting End Date:30/12/2021,

Keyskills :
customer servicequalityreturn to worksalesservice levelbusiness lettersdisability claims managementinsurancesapfunctional capacity evaluationscustomer relations