About the Role
The specialist will handle claims in both English and a second language, verify documentation, communicate with stakeholders, and ensure compliance with procedures while delivering efficient service.
Responsibilities
- Review and process insurance claims submitted by clients
- Communicate with policyholders to gather required documentation
- Verify accuracy and completeness of claim forms
- Conduct follow-ups with healthcare providers and third parties
- Maintain records in compliance with regulatory standards
- Resolve discrepancies in submitted claims
- Provide updates to clients on claim status
- Ensure claims are processed within established timelines
- Identify potential fraudulent claims and escalate appropriately
- Collaborate with internal departments for case resolution
- Translate documents between English and a second language
- Enter data into claims management systems accurately
- Adhere to privacy and data protection policies
- Respond to inquiries via phone and email
- Support team goals through consistent performance
- Participate in training and quality assurance reviews
- Stay updated on policy changes and procedures
- Assist in improving claims workflows
- Maintain professionalism in all client interactions
- Track key performance metrics for accuracy and timeliness
Nice to Have
- Certification in insurance or claims adjusting
- Experience in a multinational or remote team environment
- Familiarity with GDPR or HIPAA regulations
- Additional language proficiency beyond required pair
- Prior experience in a supervisory role
- Knowledge of automated claims processing systems
Compensation
Competitive salary based on experience
Work Arrangement
Remote position with flexible hours
Team
Part of a global customer support and claims processing team
Languages Required
Fluency in English and Spanish required; additional language skills a plus
Work Hours
Must be available during business hours in Eastern Time zone, with some flexibility required
Not available