Primarily responsible for evaluating and adjudicating claim exception requests in adherence to established work instructions.
Periodically responsible for adjudicating higher-risk exceptions not governed by established work instructions but supported through broader policies and agreements.
Effectively track, log, and monitor claims you are working on.
Navigate, prioritize, and execute client assignments in a fast-paced environment.
Proven ability to monitor, identify, and flag emerging risk trends as necessary.
Excellent verbal and written communication skills with internal and external partners.
Maintain confidentiality of information related to customers, clients, and/or associates.
Function as a resource to team members by answering and/or resolving policy questions, policy terms, program procedures, cancellation status inquiries, etc.
Maintain accurate and proficient knowledge of products, policy terms and coverages, and program procedures.
Research and review exception decisions to ensure validity and accuracy in accordance with program enrollment.
Strong organizational skills to navigate ambiguity.
Consistently achieve established team quality, productivity, and/or performance goals.
Demonstrate willingness to perform additional tasks to support team initiatives as needed.

Claims Exception Analyst – LER

Key skills