Claims Analyst

Job Description

This role evaluates and processes insurance claims accurately by reviewing documentation, assessing coverage, and detecting potential fraud while ensuring timely payouts. This role collaborates with product and cross-functional teams to enhance claims systems, support testing efforts, and drive continuous operational improvements for an optimized user experience.

Claims Evaluation and Processing

Utilize our CRM system as the primary system for claims management and processing.

Review and assess claims documentation for accuracy and completeness.

Analyze coverage and liability based on policy terms and conditions.

Determine the legitimacy of claims and identify potential fraudulent activities.

Calculate claim payouts and ensure timely and accurate processing of claims.

System Enhancement and Coordination

Coordinate with the Product Management Team to suggest Bytesforce system enhancements for claims processes

Support quality assurance and user acceptance testing (UAT) efforts, working with relevant stakeholders to align with system and customer requirements.

Operational Optimization

Work alongside business and cross-functional teams to constantly optimize operational processes and improve the product experience for both internal and external users.

Identify and suggest opportunities for process improvements and increased efficiency.

Requirements

Bachelor's Degree (Finance, Commerce, Allied Medical)

Proven experience in claims evaluation and processing, with strong skills in reviewing documentation for accuracy and completeness.

Proficient in utilizing CRM systems (preferably Bytesforce or similar) for claims management and processing.

Solid understanding of insurance policy terms and conditions to accurately analyze coverage, liability, and claim legitimacy.

Ability to detect and investigate potential fraudulent claims with a keen eye for detail.

Skilled in calculating claim payouts and ensuring claims are processed accurately and within set timelines.

Experience collaborating with product management teams to recommend system enhancements and support quality assurance, including user acceptance testing (UAT).

Strong cross-functional teamwork skills to partner with business units and technical teams in optimizing operational processes.

Proactive in identifying and proposing process improvements to increase efficiency and enhance the overall product and user experience.

Excellent analytical, communication, and problem-solving skills with a focus on operational excellence