Deskripsi Pekerjaan
Join Tenet Global Business Center, Inc. as a Claims Examiner and play a pivotal role in ensuring fair and efficient claim resolutions. In this position, you will be responsible for the accurate and timely adjudication of all claims, directly impacting customer satisfaction and operational excellence. You'll analyze complex claim documents, verify policy coverage, and make informed decisions while maintaining strict compliance with industry regulations and company standards. This opportunity offers a dynamic environment where your analytical skills and attention to detail will drive positive outcomes for both clients and the organization.
Tenet Global Business Center, Inc. values professional growth and offers a collaborative workplace where you can develop expertise in claims management, fraud detection, and regulatory compliance. If you're detail-oriented, passionate about problem-solving, and committed to delivering exceptional service, this role provides a rewarding career path in the insurance sector.
Tanggung Jawab
- Accurately adjudicate insurance claims within established timelines and service level agreements
- Review claim documentation for completeness, accuracy, and compliance with policy terms
- Investigate claim details to determine coverage validity and liability assessment
- Communicate claim decisions and requirements to claimants and stakeholders professionally
- Maintain detailed records of claim activities, decisions, and correspondence
- Identify potential fraudulent claims and escalate suspicious cases to the fraud department
- Collaborate with underwriting, legal, and provider relations teams on complex claims
- Stay updated on industry regulations and claim processing best practices
Kualifikasi
- Bachelor's degree in Business, Finance, Insurance, or related field
- Minimum 1-2 years of experience in claims processing or insurance operations
- Strong analytical skills with attention to detail and accuracy
- Proficiency in claims management software and MS Office Suite
- Knowledge of insurance regulations and industry standards
- Excellent communication and interpersonal skills
- Ability to handle confidential information with discretion
- Strong problem-solving skills and decision-making abilities