Senior Specialist, Claims

About the role

The Senior Specialist, Claims is responsible for managing and processing medical insurance claims with accuracy and efficiency. This role involves handling complex cases, ensuring compliance with policies and regulations, and supporting continuous improvement of claims processes.

Key responsibilities

• Process and assess medical claims accurately and efficiently.
• Communicate with customers to gather required information and provide timely updates.
• Apply medical knowledge to validate and evaluate claims.
• Manage the claims hotline, resolve inquiries, and maintain customer satisfaction.
• Maintain precise data entry and updates in the claims system.
• Collaborate with cross‑functional teams to resolve complex claim issues.
• Stay informed on industry regulations and internal policies.
• Prepare detailed reports on claims trends and performance for management.
• Support and train junior staff in claims handling and customer service.
• Handle escalated claims professionally, ensuring resolutions align with company values.

Required profile

• Minimum 2–3 years of experience in claims processing or a related field.
• Proven experience with data entry systems and customer service platforms (2+ years).
• Bachelor’s degree in business administration, healthcare, medical billing, or a related discipline.
• No specific licenses required; relevant certifications are a plus.

Required skills

• Data entry systems
• Customer service platforms

What we offer

• Opportunities for professional growth and mentorship.
• Flexible work environment that values well‑being and inclusion.
• Exposure to strategic claims management and reporting within a global team.