Posted by Capgemini is a global leader in consulting, digital transformation, technology and engineering services. The Group is at the forefront of innovation to address the entire breadth of clients’ opportunities in the evolving world of cloud, digital and platforms. Building on its strong 50-year+ heritage and deep industry-specific expertise, Capgemini enables organizations to realize their business ambitions through an array of services from strategy to operations.
Associate Operations Claims Support – LTC
Job Description:
• Provide Excellent Customer Service to all external and internal stakeholders
• Responsible for timely request and follow-up request of any/all required additional information, i.e. medical records/notes, appropriate forms/documents, statements and/or certificates needed for proper claim adjudication
• Respond accurately, timely and professionally to all oral and written external and/or internal correspondences
• Maintain current knowledge of LTC federal, state, and insurance regulations and requirements
• Maintain working knowledge of all company and services pertaining to business segment
• Maintain working knowledge and proficiency in company claims, administrative and imaging software systems such as Citron, Case 360, INSPRO and Microsoft applications
• Operate within company regulations regarding HIPAA, fraud, confidentiality, and private health information guidelines
• Interact professionally with other business units to gather and analyze data needed to properly to be routed to correct entity / system
Skills & Abilities:
• Experience with Microsoft Word, Excel and Outlook
• Willingness to work various schedules and adapt to a changing work environment
• Strong communication skills – verbal and written
• Ability to disseminate and learn information in a short period of time
• Efficient and accurate use of technology for data entry, documentation, and analysis
• The ability to multi-task and quickly navigate multiple business tools while maintaining quality
• Proven ability to meet deadlines
• Ability to make a positive contribution as demonstrated by learning new skills and making suggestions for process/procedure improvement
• Maintain client and company quality and production standards
• Maintain knowledge of applicable company policies and procedures
Education & Experience:
To perform this job successfully, an individual must be able to perform each essential duty effectively. The Claims Support member should have some product knowledge and insurance experience and a claims background are preferred.
One to Two years certificate/degree from college or technical school; or 2-5 years related experience and/or training; or equivalent combination of education and experience.