We are hiring for one of India's leading IT & consulting organizations for the position of Claims Processing & Adjudication Specialist.
Summary:
Claims Processing & Adjudication Specialist is responsible for reviewing, validating, processing, and settling employee benefit claims and corporate reimbursement requests according to company policies, eligibility criteria, and Service Level Agreements.
- To Apply for above Claims Processing & Adjudication Specialist, WhatsApp 'Hi' @ (phone hidden)
- When Asked For The job Code, Type: Job Code # 245
Key Skills:
- Minimum 5 years of experience in Claims Processing & Adjudication.
- Experience handling employee reimbursements, benefits claims, and salary advance processes.
- Experience supporting international employee populations and global stakeholders.
- Any Graduate.
- Process and adjudicate employee benefit claims accurately and within defined timelines.
- Review, verify, and validate claim documentation as per organizational policies and guidelines.
- Handle various claim types, including:
- Gym Reimbursement Claims
- Vaccination Claims
- Wellbeing Benefits Claims
- School Reimbursement Claims
- Salary Advance Claims
- Other employee benefit-related reimbursements
- Identify discrepancies and exceptions in claims and ensure timely resolution.
- Maintain high levels of accuracy and compliance throughout the claims lifecycle.
2. Stakeholder Management
- Collaborate with global stakeholders to ensure alignment with claims policies and standards.
- Partner with internal HR teams, employees, vendors, and third-party service providers.
- Provide timely communication and support regarding claim status and resolutions.
3. SLA & KPI Management
- Ensure adherence to defined Service Level Agreements (SLAs).
- Monitor claims turnaround times and quality metrics.
- Consistently meet or exceed established Key Performance Indicators (KPIs).
- Support operational reporting and performance reviews.
4. Compliance & Continuous Improvement
- Ensure compliance with company policies, audit requirements, and regional regulations.
- Maintain complete and accurate claims records.
- Identify process gaps and recommend improvements to enhance efficiency and employee experience.
- Participate in process improvement initiatives and operational excellence programs.
5. Systems & Tools
- Work with HR and perks administration systems for claims processing.
- Utilize ticketing and workflow management tools to monitor and manage claim activities.
- Maintain accurate documentation and tracking of all transactions.