Medical Claims Specialist | Foundever

JOB DESCRIPTION : This role involves delivering exceptional customer service, primarily through inbound calls, addressing inquiries about healthcare policy provisions from employer-provided plans. Outbound calls are also conducted as dictated by client-specific processes.

Work-Life Balance: Enjoy a 5-day work week with 2 rotational days off

Global Shift Alignment: Work primarily during US business hours "Night shift's".

Hiring for Fresher's and Experienced

(should possess exceptionally great communication skills in English)

Skills & Knowledge

Fluent in business English (written and spoken).

Compensation & Perks:

Free transportation service available for commutes within a 30km radius

2 Way Cab Facility (home pickup and home drop)

Education

High School Diploma or equivalent required or any degree preferred.

Key Responsibilities Include:

Information Delivery:

• Review of the Family Medical Leave Act (FMLA), state, company, and other absence certifications as

mandated by state and federal guidelines and in coordination with our customers policies

• Provide accurate, professional, and timely responses to communications from internal and external

partners

• Contact medical providers to obtain or clarify medical facts supporting the need for a leave of absence
• Maintain complete and accurate documentation of leaves within our proprietary database
• Correspond with clients regarding leave status and assist with decision making
• Process reports for clients and short-term disability partners
• Input and analyses data
• Demonstrate respect, sensitivity, and confidentiality, while always maintaining professionalism.
• Meet and adhere to production and quality goals as well as performance metrics.
• Responsible and accountable for maintaining and protecting personal, confidential claimant health

information. Must maintain a high level of confidentiality and abide by HIPAA rules and regulations.

• Engage in ongoing education and training around laws, policies and service delivery.
• Support management with special projects as necessary
• Other duties as assigned

Professional Conduct: Performing all responsibilities consistently and professionally, utilizing strong verbal, interpersonal, and quality service skills.

Multichannel Support: Handling inbound customer calls courteously, timely, and professionally, including managing inquiries via email and live chat.

Active Listening & Problem Solving: Actively listening to customers, understanding their needs, and resolving issues effectively.

Escalation Management: Escalating customer issues to appropriate staff and management for resolution as needed.

First Call Resolution: Ensuring first call resolution through effective problem-solving and call handling.

Process Adherence: Strictly following client program processes and performing all tasks courteously and professionally.

Knowledge Utilization: Utilizing knowledge base resources and training to accurately answer customer questions.

Record Keeping: Creating and maintaining accurate customer records with detailed call information.

Documentation: Accurately documenting call resolutions in the appropriate systems.

Financial Compliance: Strictly adhering to client processes for handling financial issues and inquiries.

Confidentiality: Complying with all requirements concerning confidential and personal information.

Policy Adherence: Following all required scripts, policies, and procedures.

Schedule Compliance: Adhering to all attendance, work schedule, and scheduled training requirements.

Rounds of Interview:

HR Round

Online Assessment

Manual Voice Assessment

Operational Round

If you meet the above criteria and are eager to be part of a dynamic team,

please send your resume via WhatsApp or call to this number

Shravani: [phone removed]