HR Claims Lead

Overview

An HR claims specialist processes and manages claims related to employee benefits, such as reimbursements or other financial claims, ensuring compliance with policies and procedures. This role involves tasks like verifying and computing claims, monitoring settlement status, resolving discrepancies, and providing customer service to employees and panel providers. The position requires strong analytical skills, attention to detail, and proficiency with claims management systems.

Responsibilities

• Claims Processing : Reviewing, processing, and adjudicating employee claims for benefits, reimbursements, or other allowable claims.
• Verification and Accuracy : Computing and verifying the accuracy of claims and reimbursements to ensure correctness.
• Investigating and resolving discrepancies, customer complaints, and escalations related to claims.
• Customer Service : Providing quality customer service and assistance to employees, panel providers, and other internal and external clients.
• Monitoring and Follow-up : Diligently monitoring and following up on unsettled claims and outstanding information from stakeholders.
• System Management : Managing claims status, using claims management software, and ensuring compliance with company guidelines and regulations.
• Reporting : Potentially preparing audit reports to support cost control and client satisfaction.

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