Claims Senior Representative

Responsibilities

• Manage end-to-end medical claims processing, ensuring accurate adjudication, timely turnaround, and resolution in line with policy terms and SLA requirements.
• Provide coaching, training, and ongoing guidance to claims handlers, particularly on complex cases, to drive accuracy, productivity, and overall team performance.
• Act as a subject matter expert for clients and internal stakeholders, addressing escalations, providing claim updates, and ensuring a high level of service delivery.
• Cross-functional Collaboration : Partner closely with internal teams and other books of business to resolve claims efficiently and improve overall operational effectiveness.
• Compliance & Governance : Ensure all claims are processed in accordance with regulatory requirements, company policies, and internal quality standards, maintaining high audit and compliance scores.
• Process Improvement & Strategy : Iden...