KSA Claims Examiner

Job Overview
You are an experienced Claims Examiner who is skilled at excel, can handle a large claims load, multi-task, and meet tight deadlines. You thrive in a fast-paced environment providing excellent customer service in both the turnaround of the claim and handling emails and incoming calls. You will have the desire to develop an in-depth understanding of this position and be able to easily maneuver through between assessing claims and inquiries. You are a very strong team player.
The Claims Examiner will be responsible for processing a variety of different claims and communicating
these decisions to providers and clients. This role requires strong time management skills,
claims experience, and strong excel skills.

Responsibilities
• Process EU and UK health, dental and pharmacy claims
• Adjudicate claims based on approved Letter of Guarantee periods for the client
• Provide excellent customer service for claims matters both verbal and via written
correspondence
• Handle both inbound and outbound calls to EU/UK health providers as required
• Ensure all work complies with the PIPEDA and GDPR
• Reconciliation of claims with healthcare providers
• Data Entry is required to key in scanned claims/invoices into the claim management system (V9)
• Maintain concise file documentation consistent with corporate policies
• Provide overall portfolio management of assigned claims files
• Provide guidance and mentorship to peers
• courier/mail management
• Other related duties as assigned

Required Skills
• Experience in the EU/UK health insurance industry is required
• Minimum 2-3 years of claims processing experience
• Experience in processing health, dental, and pharmacy claims
• High level of proficiency in Microsoft Office suites, specifically Excel
• Excellent verbal and written communication skills
• Strong time management and organizational skills
• Strong analytical and problem-solving skills
• Professional level proficiency in English language

Preferred Skills
• Cost containment/provider relations experience
• Professional/Business level proficiency in German language is an asset.
• Experience with German and UK medical coding standards
• Dispute resolutions experience

Additional Notes
• The hours for this position are 8am-4pm EST from Monday through Friday. Occasional overtime on
evenings and weekends might be required as per business need.