TL-Claims HC

Job Summary

The TL-Claims HC role requires a seasoned professional with 6 to 8 years of experience in claims management specifically focusing on Facets - Claims and Claims Adjudication. The candidate will work from the office during night shifts handling dental and commercial claims efficiently. Proficiency in English is essential for effective communication.

Responsibilities

• Oversee the claims adjudication process to ensure accuracy and compliance with company standards.
• Provide expert guidance on Facets
• Claims system to streamline operations and enhance productivity.
• Manage dental and commercial claims with precision to minimize errors and optimize claim processing time.
• Collaborate with cross-functional teams to improve claims handling procedures and customer satisfaction.
• Analyze claims data to identify trends and implement strategies for process improvement.
• Ensure all claims are processed in accordance with regulatory requirements and company policies.
• Develop training materials and conduct workshops to enhance team skills in claims management.
• Monitor claims workflow and adjust resources to meet operational demands effectively.
• Facilitate communication between stakeholders to resolve complex claims issues promptly.
• Utilize advanced analytical skills to forecast claims trends and prepare reports for management.
• Implement best practices in claims adjudication to maintain high standards of service delivery.
• Support the development of new claims handling protocols to adapt to changing industry standards.
• Drive initiatives to enhance the efficiency of claims processing through innovative solutions.
  
  

Qualifications

• Demonstrate proficiency in Facets
• Claims system and claims adjudication processes.
• Possess in-depth knowledge of dental and commercial claims management.
• Exhibit strong analytical skills to interpret claims data and drive improvements.
• Show excellent communication skills in English to liaise with stakeholders effectively.
• Have a proven track record of managing claims operations in a fast-paced environment.
• Display ability to work night shifts and adapt to office-based work model.
• Bring experience in developing training programs for claims management teams.
  
  

Certifications Required

Certified Professional in Healthcare Quality (CPHQ) Facets Claims Certification