Claims Administrative Executive

We are seeking qualified and professionl personnel for the above role

1. Processing Claims: Manage the end-to-end process of handling insurance claims, including receiving, reviewing, and processing claims submitted by clients or policyholders.

2. Documentation: Ensure all necessary documentation and information related to claims are accurately recorded, maintained, and updated in the company's database or records management system.

3. Investigation: Conduct thorough investigations into the validity of claims, including verifying policy coverage, assessing damages or losses, and gathering relevant evidence or documentation.

4. Communication: Serve as a primary point of contact for claimants, policyholders, and internal stakeholders, providing timely and courteous assistance, answering inquiries, and resolving issues or disputes related to claims.

5. Adjudication: Evaluate claims based on policy terms, coverage limits, and applicable regulations to determine the appropriate settlement amount or course of action.

6. Settlement Processing: Negotiate settlements with claimants or their representatives, ensuring fair and equitable resolutions in accordance with company policies and procedures.

•7+ years of experience in claims management and tariff negotiation within the healthcare industry

•Proven track record of implementing process improvements to enhance claims efficiency and reduce costs.

•Strong background in data analysis and demonstrated ability to work with data to solve complex problems, utilizing advanced analytical tools and methodologies.

•Strong understanding of rules-based automated claims processing systems and prior authorization workflows

•Experience in tariff negotiation, provider network management, and benefits design across diverse markets.

•Excellent leadership and communication skills, with the ability to collaborate effectively across cross-functional teams.

•A Nursing or bachelor’s degree in healthcare administration or business Management, with a preferred background of master’s level studies in data analysis or business administration