Duties and Responsibilities To efficiently investigate and process claims, and administer the validation of medical subscriptions, implementing streamlined processes and procedures and provide business support on all operational aspects within your team and your department.
Claims: Assess and process claims within the PPI portfolio according to relevant policy terms and conditions.Process and decision claims over the delegation for all businesses based on recommendations received from TPA and according to the relevant policy terms and conditions.
Confirm approval to TPA.Provide customer service for inbound and outbound calls.Check monthly reporting per partner for its accuracy and completeness.Check Claims transfer request forms and sign off monthly/weekly confirming accuracy.Propose process improvements to the processing investigation and settlement of claims.Report on productivity to Team Leader/Manager.Provide business support where required in Operations area.Maintain an individual internal quality level > 95% on a monthly basis.Medical Subscriptions (if applicable): Administer subscriptions input and validation following recommendations from medical underwriters.Ensure proper communication between the team staff in the Dublin office, the local TPAs, and medical underwriters to ensure timely decisions are communicated to the partners following service standards.Complaints Management Backup (if applicable): Assist in the management and reporting of complaints when the complaints analyst is out of the office or if needed.Ensure and follow the complaints procedure associated.Business Support: Assist in creating and updating claims and subscriptions procedures as necessary for new and existing business.Assist the Team Leader in ensuring that all business documentation for the department is up to date, filed, and archived.Present suggestions for reviewing and updating procedures to Team Leader and implement, coordinate, and monitor any upgrades to procedures as they are signed off.Provide training both internally and externally.Maintain various regular and ad hoc reports and provide them to your Team Leader.Perform other work or projects as selected by the Team Leader or Operations Manager.
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