Claims Queries Agent

Job Description

• Handle incoming queries from healthcare providers via phone, email, and other communication channels.
• Provide accurate and timely information in response to provider inquiries.
• Escalate complex queries to appropriate departments or senior staff members as necessary.
• Maintain detailed records of all queries and their resolutions.
• Identify areas for improvement based on query analysis and feedback.
• Communicate clearly and effectively with healthcare providers, ensuring a high level of satisfaction.
• Collaborate with internal teams to resolve issues and provide comprehensive responses to providers.
• Keep providers informed about updates, policy changes, and other relevant information.
• Participate in training and development activities to stay current with industry standards and company policies.
• Adherence to internal procedures and guidelines, client service agreements and compliance & regulatory standards
• Take ownership of each query ensuring all aspects of the query are answered right first time, eliminating rework and increased customer effort
• Provide clear, concise and accurate responses in a professional manner, including internal and external information transfer
• Provide direction, next steps and clear expectations to the client where a query involves further investigation or requires further information
• Contribute to the team and department SLA ensuring queries are managed efficiently and effectively
• Exhibit a proactive approach to the clients, ensuring an ongoing focus on enhancing the customer experience through process improvements and simplification
• Ensure accurate recording and Categorisation of all queries in the sy
• Support department and colleagues to ensure overall business targets are achieved
• Other Ad hoc duties as required
• AI READINESS Work effectively in an environment shaped by artificial intelligence (AI), machine learning, data, analytics and cloud-based tools, using insights responsibly with our standards of data governance, security and ethical use.
  

What You Bring

• Bachelor’s degree in any Medical field, Paramedical, Finance, Business Administration, Insurance, or a related field preferred.
• With 2 years experience in a customer focused environment, ideally in clinical, paramedical roles or TPA or insurance roles.
• Excellent verbal and written communication skills.
• Strong problem-solving and analytical abilities.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
• Ability to work independently and as part of a team.
• Strong organizational skills and attention to detail.
• Ability to prioritise workload and manage time effectively
• Experience in claims processing
• Legally permitted to work in the country of operations.
• Hybrid working option available as per business requirements.