Us In Driving Growth
ClaimsRepresentative(GEHAPAC)
“Claims Representative (GEH APAC) at Us In Driving Growth. Skills: claims processing, medical insurance policies, eligibility assessment, policy adherence, quality maintenance, productivity, responsiveness, collaboration, SLA adherence, KPI achievement, quality audit scores, NPS, medical confidentiality, data input, cost management, workload management, process optimization, claims handling, reimbursements, transactions, high-cost claims monitoring, SOP adherence, benefit policy adjudication, fin”
What You'll Achieve.
Achieves required processing targets assigned by the team leader on daily, weekly and monthly basis; Meet or exceed Service Level Agreement requirements, team KPI(s), monthly quality audit scores and NPS (Net Promoter Score); A sustained effort towards high-quality claims handling, accurate reimbursements and fast transactions are important motivators
Industry & Context.
resolving problems; Positioning him/herself analytically and critically; Adjust error claims according to actual situation
Should be flexible to work in shifts and on staggered weekends for overtime
What They're Looking For.
Must Have
administration awareness and experience, essential, skills in Microsoft Office applications, essential, First class written and verbal communication skills, essential, Ability to communicate across a diverse population, essential
Nice to Have
Experience of working for an international company, preferred but not essential, Claims processing or insurance experience, preferred but not essential, Broad awareness of medical terminology, advantageous
What You'll Do.
serving providers and insurance companies by determining requirements
fulfilling requests and maintaining database
processing as per terms of benefits
provide accurate and relevant medical coverage details
maintain pre-approvals and claims processing as per the defined terms and policies of the organization
Processes claims from members and providers
Assists queries from providers and payers via phone calls or e-mails
Maintains files for authorizations and other reports
Assesses and processes claims in line with the policy coverage and medical necessity
Be fully versed with medical insurance policies for various groups / beneficiaries
May assist in training colleagues and asked to share knowledge
Accurately assesses eligibility within the policy boundaries
Monitors and maintains the claims processing as per the defined terms and policy of the organization
Monitors the qualitative and quantitative measures for claims & pre-approvals
Ensures compliance to any changes in terms of system parameters or process
Maintains quality as per framework for accuracy
Maintains productivity and responsiveness to the work allocated
Assessing and processing claims for medical expenses while always bearing in mind the importance of medical confidentiality
Accurate data input to the system applications
Positioning him/herself analytically and critically in the context of cost management and in respect of existing working methods
Following up own workload (volume and timing): keeping an eye on chronology and processing time of the work volume and taking suitable actions
Participate efficiently in processing the flow of claims: inform the supervisor about claims lacking clarity and about possible ways of optimizing the processes
Monitor and highlight high-cost claims and ensure relevant parties are aware
Follow Claim Manual and SOP strictly
adjudicate claims according to benefit policies
and meet both financial/procedure accuracy and TAT target on claims adjudication
Adjust error claims according to actual situation
Well handle recoupment and reconciliation work
communicate with providers and members via call and email for collection and explanation
How You'll Work.
Team & Collaboration
Collaborate with other stakeholders / teams to resolve queries including complex queries; Actively support all team members to enable operational goals to be achieved; Work with cross function teams, such as Finance, CSR, Eligibility, Network, Client Management, etc. Ensure recoupment work go smoothly; Actively support Team Leader and work with claim colleagues to enable all operational goals to be achieved; building effective relationships with all his matrix partners; foster internal and external communication standards
Communication Scope
First class written and verbal communication skills; Ability to communicate across a diverse population; communicate with providers and members via call and email
Applying for this Claims Representative (GEH APAC) role?
Most applicants get filtered before a human reads their resume. See if yours makes the cut.
How to Apply on Workday
- Workday has a multi-step form — save your progress after every section.
- "Apply With LinkedIn" can fail or lose data; manual entry is more reliable.
- Watch for the "Submit for Review" final step — hitting "Save" alone does not submit.
- Job requisition numbers are useful when following up with HR by email.
ANONYMOUS · UNFILTERED
What do employees actually say about Us In Driving Growth?
Real rants from real employees. Read before you apply.