Senior Specialist, Claims

About the role

The Senior Specialist, Claims is responsible for managing and processing insurance claims with precision and efficiency. This role handles complex medical claims, ensures compliance with policies and regulations, and contributes to 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, resolving inquiries and ensuring 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, aligning resolutions with company values.

Required profile

• Minimum 2–3 years of experience in claims processing or a related field.
• At least 2 years of experience with data entry systems and customer service platforms.
• Bachelor’s degree in business administration, healthcare, medical billing, or a related discipline.
• Relevant certifications are a plus, though not required.
• Strong analytical, problem‑solving, and communication skills.
• Ability to manage high volumes of inquiries and multitask effectively.
• Experience working both independently and collaboratively in a team setting.

Required skills