This is a fully remote position, open to applicants in Florida, +1 more state.

📋 Description

• Evaluate submitted claims to identify incidents, ascertain applicable coverage according to policy terms, and compute eligible reimbursement benefits.

• Approve or reject claims based on the stipulations of the insurance agreement.

• Notify customers of claim outcomes via letter, email, or telephone.

• Address customer inquiries regarding claim status, required documentation, or general information.

• Record claim decisions, notes, and actions in PeopleSoft.

• Work in partnership with internal departments to acquire or verify missing or ambiguous claim details.

• Investigate discrepancies and escalate complex or questionable claims to the Team Leader.

• Distribute claim forms to new customers as necessary.

• Utilize AI, machine learning, data analytics, and cloud-based tools effectively while adhering to data governance, security, and ethical-use standards.

⛳️ Requirements

• A high school diploma or equivalent is mandatory.

• A strong eagerness to learn, develop, and establish a long-term career.

• Exceptional attention to detail and robust organizational skills.

• Outstanding written and verbal communication skills.

• Capability to work autonomously as well as cooperatively in a team setting.

• Applicants must be residents of either Virginia or Florida.

• Prior experience in claims processing is advantageous but not essential.

• Familiarity with PeopleSoft or similar claims management systems is beneficial.

• Responsible utilization of AI, machine learning, data analytics, and cloud-based tools in line with data governance, security, and ethical-use standards.