Analyze & process claims by investigating & obtaining a wide range of complex information. Apply claim policies & procedures and engages intervention of internal/external resources to ensure fair, ethical, & timely management of assigned claims.
Analyze and interpret complex coverage contracts to determine if eligibility is met.
Identify, interpret, and resolve gaps in financial calculations and offsets when applicable, share technical knowledge and approach on financial calculations with team members that involve complex contract provisions.
Research questions and escalations from Claims team; liaises with various stakeholders from across the business (Underwriting, Actuarial, Compliance, Account Management, etc.) to obtain needed information to clarify and address issues.
Provide customers with in-depth explanations of policy details, claim process, and claim determination; ensure parties un...