General Claims Specialist

Overview

An HR Claims Specialist processes and manages various types of employee claims, including benefits, reimbursements, and workers' compensation, ensuring compliance with company policies and regulations. Key responsibilities involve verifying claim accuracy, investigating issues, maintaining detailed records, and communicating effectively with employees and external parties. The role requires strong analytical, organizational, and customer service skills, along with proficiency in claims management systems.

Responsibilities

• Process and Verify Claims : Review and process employee claims (e.g., benefits, reimbursements, workers' compensation) for accuracy, completeness, and compliance with policies and legal requirements.
• Investigate and Resolve Discrepancies : Investigate claim issues and discrepancies, gathering necessary information and documentation to resolve them.
• Manage Claims Data : Maintain accurate and organized records of all claim processing activities and outcomes.
• Ensure Policy Compliance : Ensure all claims processing activities comply with company policies, state, and federal laws.
• Communicate with Employees : Provide excellent customer service to employees regarding their claims, guiding them on company policies and procedures.
• Collaborate with Stakeholders : Liaise with internal departments, insurance providers, and other third parties as needed to facilitate claim resolution.
• Report and Analyze Trends : Analyze claim data to identify problem areas and report unusual or unresolved issues to the HR Manager.

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