38 Claims Operations Jobs - Page 2

In this role, you will: Supervise a team of specialists within a fraud and claims program for proactive fraud identification, prevention, and detection, as well as ensuring the recovery, execution, and handling of claims Identify opportunities for process improvement and risk control development in fraud and claims management to maximize efficiency and enhance customer service Make supervisory decisions and resolve issues related to work distribution under direction of fraud and claims management Leverage interpretation of internal processes and procedures to establish performance standards, evaluate performance, develop training materials, and ensure compliance with internal policies, risk ...

About this role: Wells Fargo is seeking an Associate Fraud & Claims Operations Representative. In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more expe...

About this role: Wells Fargo is seeking an Associate Fraud & Claims Operations Representative. In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more expe...

In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more experienced roles Interact with colleagues on basic day-to-day issues, and network with supporting ...

About this role: Wells Fargo is seeking a Fraud & Claims Operations Representative. In this role, you will: Support fraud and claims functional area by proactively identifying opportunities to improve customer experience, and offer ideas to mitigate risks through effective authentication of customers in order to prevent fraudulent activity Perform moderately complex customer support tasks by utilizing solid communication, and verbal and written skills to establish rapport with customer and to deescalate difficult, as well as sensitive information as a part of resolving a claim Oversee multiple claim types, take appropriate action to decision the case using multiple systems and applications, ...

About this role: Wells Fargo is seeking a Senior Fraud & Claims Operations Representative . In this role, you will: Support fraud and claims functional area by proactively identifying opportunities to improve customer experience, and offer ideas to mitigate risks through effective authentication of customers in order to detect and prevent fraudulent activity Perform complex customer support tasks by utilizing solid communication (inbound and outbound), verbal and written, skills to establish rapport with customer and to deescalate difficult, as well as sensitive information researched as a part of resolving a claim Oversee multiple claim types, take appropriate action to decision the case us...

About this role: Wells Fargo is seeking an Associate Fraud & Claims Operations Representative. In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more expe...

About this role: Wells Fargo is seeking a Associate Fraud & Claims Operations Representative. In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more exper...

In this role, you will: Support fraud and claims functional area by proactively identifying opportunities to improve customer experience, and offer ideas to mitigate risks through effective authentication of customers in order to prevent fraudulent activity Perform moderately complex customer support tasks by utilizing solid communication, and verbal and written skills to establish rapport with customer and to deescalate difficult, as well as sensitive information as a part of resolving a claim Oversee multiple claim types, take appropriate action to decision the case using multiple systems and applications, and may contact third parties for research, as needed Receive direction from supervi...

About this role: Wells Fargo is seeking an Associate Fraud & Claims Operations Representative In this role, you will: Support and capture all pertinent information from customers about their claims Conduct research and provide updates on status of new and existing claims Identify opportunities to improve customer experience after thorough research of complex account activity, and take appropriate actions to handle the claim Perform routine customer support tasks by maintaining balance between exceptional customer service and solid investigative research while answering incoming calls in a call center environment Receive direction from team lead and escalate questions and issues to more exper...

Provides clinical review expertise for high dollar and complex claims, including facility and professional bills. Provides cost containment services by identifying coding and billing errors and insuring application of Medical and Reimbursement Policies. Additionally identifies cases for potential fraud and abuse and makes referrals. Major Job Responsibilities Evaluates medical information against criteria, benefit plan, coverage policies and determines necessity for procedure and refers to Medical Director if criteria are not met Evaluate itemized bills against reimbursement policies Adheres to quality assurance standards Serves as a resource to facilitate understanding of products Handles s...

Full Time Opportunity Location: Goa/Kolkata/Patna/Assam/Jharkhand/Jamshedpur Job Description: - As a claim processing executive you will be responsible for handling all claim related activities on day today basis. - Checking all documents submitted by customers. - Verification of all documents with doctors, hospitals to cross check them for further process. - Coordination with customer if any document is missing or fake. Mentioning remark on every documents. - Coordination with head office to submit claim reports. - Coordination with branch head and other managers for smooth work process. - Maintaining MIS report on daily basis Qualification : MBBS, BAMS, BHMS Experience : 2 to 10 years in h...

- As a claim processing executive you will be responsible for handling all claim related activities on day today basis. - Checking all documents submitted by customers. - Verification of all documents with doctors, hospitals to cross check them for further process. - Coordination with customer if any document is missing or fake. Mentioning remark on every documents. - Coordination with head office to submit claim reports. - Coordination with branch head and other managers for smooth work process. - Maintaining MIS report on daily basis Qualification : MBBS, BAMS, BHMS Experience : 2 to 10 years in health insurance claim processing