Company Description:
As a Claims Specialist, you will manage a workload of claims independently in accordance with established procedures and guidelines. You will be responsible for conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You’ll complete a thorough training program to develop new skills and give you the confidence you need to be successful in your new role.
Job Description:
- Communicating with claimants, employers and various medical professionals through e-mail to gather information regarding hospital Claims and state and federal benefits when applicable
- Collaborating with fellow case managers, nurse case managers, vocational case managers, and consulting physicians to make appropriate, ethical, and timely claim determinations
- Reviewing complex medical records and effectively leveraging a variety of tools and resources to understand appropriate approval durations and future action planning throughout the life of the claim
- Providing exceptional customer service and proactively recognizing customer needs and areas of opportunity
Qualifications:
- A minimum of 4 CXC/GCE subjects inclusive of English Language, or a U.S. high school diploma or GED.
- Must have a valid (not expired) government issued ID, TRN and NIS card.
- Must have flexible availability to work any day and any assigned shift weekly.(Weekends and Public Holidays).
- Must be able to train and / or work onsite.
- Demonstrated ability to perform at a high level, to support our high volume of inbound calls.
- Experience in customer service is an asset and preferred.
- Good systematic problem solving ability , using sound business judgment, and following through on commitments to customers.
- The ability to quickly and accurately identify and assess individual customer needs and take appropriate action steps to satisfy those needs.
- Excellent attention to detail.
- See through the eyes of the customer.
- Excellent verbal and written communication skills; able to translate Customer communication rapidly and effectively on live voice or chat interactions. proficient reading skills required.
- The ability to project patience, empathy, caring, and sincerity in written words or voice tone, depending on channel.
- Ability to effectively organize, prioritize, multi-task and manage time.
- Multi-tasking skills, showcased through conversing while navigating our systems the use of several applications simultaneously; experience working with CRM applications preferred.
- Good Typing Skills – Minimum 35 wpm with minimum 80% accuracy.
- High level of integrity
- Basic PC keyboarding skills; basic Microsoft Office (Outlook, Word, Excel) experience required.
- Must be very tech savvy with strong abilities in handling troubleshooting techniques and resolving technical issues.
- Inspire confidence and positively influence the behaviour, actions, and thoughts of others.
- Must be able to pass a criminal background check and drug test as needed.
Additional Information:
All your information will be kept confidential according to EEO guidelines.
As your prospective employer, we need to process your Personal Data as needed to evaluate your qualification for the position you are applying for with Sutherland. During the recruitment process, your Personal Data may be transferred outside of Jamaica and disclosed to third parties in the normal course of the recruitment and/or employment process or as needed to comply with applicable laws. This may include transferring information to our affiliated Companies for purposes connected to your employment with the company or to the management of Sutherland’s business.
