What are the responsibilities and job description for the Claims Resolution Specialist position at Acosta Group?
About the Role
This position is responsible for processing and handling claims that are incomplete or escalated for validation. The ideal candidate will have a strong analytical mindset and excellent communication skills to work with internal and external business partners.
Key Responsibilities
- Process escalated claims, assess the reason for escalation, and provide resolution in priority order as directed by the Supervisor.
- Search for and link invoices, contracts, and Proof of Performance to claims as needed.
- Use systems, reports, and Standard Operating Procedures to work assigned claim steps and gather supporting claims information.
- Process invalid claims in accordance with set policies and guidelines.
- Correct and resolve claims clean passed in error.
- Research validation issues and recommend appropriate solutions.
- Review claims dashboard for actionable items on a frequent basis.
- Meet or exceed client and customer goals and requirements.
- Making the final decision on claims validity for escalated claims.
- Sending compliant promotion package for clearing.
- Contacting Sales, clients, customers, and management team for information as needed.
- Proactively managing client and customer target dates to ensure claims are processed in a timely manner.
- Communicating with clients and customers on a regular basis and providing value-added solutions.
- Escalating appropriately to the supervisor when needed to get information or handle complex client and customer situations.
- Understanding types of escalations and using problem-solving and analytical skills to resolve them so they do not repeat.
- Working to decrease defects and achieve automation targets by keeping Standard Operating Procedures updated.
- Monitoring specific escalations data to determine the root cause of an escalation, where it originated, and why it occurred.
- Discussing defect issues with Sales, clients, customers, and management team and working with them to address the root cause.
- Recognizing and providing solutions for operational obstacles that delay work completion on claims issues.
