Claims Officer

Client of Besst Group

Key Responsibilities

• Serve as the primary point of contact for clients, hospitals, TPAs, and insurance companies throughout the claims process.
• Actively advocate for clients' best interests, ensuring prompt and equitable resolution of claims.
• Build strong relationships with clients, providers, and insurers to facilitate efficient communication and problem-solving.
• Provide timely and accurate updates to clients on the status of their claims.
• Identify and address potential issues or delays in the claims process.
• Keep track of pending claims and follow-up on their resolution.
• Prepare periodic reports on claims and production along with feedback.
• Work on data entry, ensuring accuracy and correcting any discrepancies.
• Provide clients with prompt and accurate responses to inquiries regarding plans, coverage details, copayments, deductibles, premiums, and claims procedures and or reimbursement.
• Develop and implement effective strategies to resolve complex claims in close coordination with the direct manager.
• Maintain a high level of customer satisfaction through exceptional service and communication.
• Stay up-to-date on industry products, solutions, regulations, policies, and procedures.
• Efficiently handle incoming calls and inquiries from clients regarding insurance coverage and claims and general inquiries through the EB hotline, even on weekends and days off.
• Proactively follow up with insurance companies and clients to ensure timely payment of insurance claims and receipt of reimbursements.
• Manage financial aspects of client accounts, including processing claims payments, reconciling claims statements, and coordinating reimbursements.
• Provide clients with clear and concise explanations regarding insurance coverage, billing, and payment options.
• Identify and address any financial concerns or discrepancies promptly to the direct manager.
• Meticulously track and follow up on documents and paperwork to ensure timely completion and submission.
• Assist the EB Department in all reports and presentations such as but not limited to loss ratio preparation and analysis when needed.
• Coordinate and monitor the production process, including renewals, quotations, additions, and deletions.