Job Summary
This hybrid role as a specialist in insurance claims focuses on delivering exceptional customer service to workers compensation claimants and stakeholders in a multilingual environment. The candidate will handle day shift responsibilities with no travel using Spanish language skills to support accurate claim processing empathetic communication and timely resolution. The role contributes to fair outcomes for injured workers and supports operational efficiency for a global organization by ensu
Responsibilities
- Manage end to end workers compensation claims processing by capturing detailed incident information and ensuring every claim is documented accurately to support timely and fair adjudication for all parties involved.
- Provide empathetic and efficient customer service to claimants employers medical providers and internal teams by responding to inquiries promptly and clearly to improve claimant experience and reduce resolution cycle times.
- Coordinate claim activities in a hybrid work model by using digital tools and secure systems to maintain continuity of service across on site and remote settings while safeguarding confidential information.
- Conduct thorough claim reviews by verifying eligibility coverage and required documentation to minimize errors reduce potential disputes and support compliant claim decisions aligned with company standards.
- Maintain detailed claim notes in the claims management system by recording conversations decisions and follow up actions to ensure clear audit trails and operational transparency for team members and regulators.
- Communicate fluently in Spanish in both written and spoken form when interacting with claimants and stakeholders to break language barriers enhance understanding and ensure equitable access to claim information and support.
- Collaborate with medical professionals legal contacts and employer representatives by sharing accurate claim updates to support coordinated care plans and consistent application of workers compensation policies.
- Resolve routine claim issues by proactively identifying missing information bottlenecks or misunderstandings and addressing them with clear explanations to improve claim throughput and reduce rework.
- Adhere to day shift schedules and productivity expectations by managing daily caseloads efficiently and prioritizing tasks to meet service level agreements and maintain high customer satisfaction.
- Monitor claim status milestones by tracking key dates payments and approvals to ensure claim progression stays on target and stakeholders receive timely updates on outcomes.
- Escalate complex or disputed claims to senior team members when necessary by providing structured case summaries that aid swift review and informed decision making without delaying claimant support.
- Follow company policies and applicable workers compensation regulations by applying guidelines consistently to maintain compliance protect organizational integrity and support fair claim outcomes.
- Support continuous improvement activities by sharing observations on recurring claim issues and customer pain points so process owners can refine workflows and enhance overall service quality.
Qualifications
- Demonstrate solid experience in customer service environments by managing high volume interactions with professionalism and empathy to maintain trust and satisfaction among claimants and stakeholders.
- Apply domain knowledge in workers compensation claims by understanding benefit structures injury reporting requirements and return to work considerations to support accurate and relevant decisions.
- Utilize strong Spanish reading writing and speaking skills to interact with diverse client populations and to interpret documents and correspondence without reliance on translation resources.
- Employ effective communication and interpersonal skills to explain claim processes next steps and decisions in clear terms that are easy for claimants and partners to understand.
- Show proven ability to work successfully within a hybrid work model by managing tasks and collaboration tools efficiently both on site and remotely while maintaining consistent service quality.
- Use detail oriented and organized working habits to manage multiple claims simultaneously track deadlines and prevent oversights that could delay benefits or create compliance risks.
- Apply basic proficiency in office productivity and claims platforms to navigate systems enter data correctly and generate routine reports that help monitor claim progress and performance.
Certifications Required
Preferred certification in claims or customer service such as Associate in Claims or equivalent workers compensation training.
关于高知特 (Cognizant)
高知特(Cognizant)（纳斯达克代码：CTSH）作为一家AI Builder和相关技术服务提供商，致力于通过打造全栈AI解决方案，帮助企业将人工智能投资转化为实际价值。公司凭借深厚的行业经验、流程优化和工程技术专长，将企业独特的业务场景融入科技系统，赋能组织释放人才潜能，推动切实成果，并帮助全球企业在瞬息万变的环境中保持领先。如需了解更多详情，敬请访问 cognizant.ai 或关注@cognizant。
补充雇佣信息
薪酬信息截至本职位发布之日为准。Cognizant 保留在适用法律允许的范围内随时修改该信息的权利。
申请人可能需要通过现场面试或视频会议的方式参加面试。此外，候选人在每次面试时可能需要出示其当前所在州或政府签发的有效身份证件。
Cognizant 是一家提供平等就业机会的雇主。在招聘过程中，您的申请和候选资格不会因种族、肤色、性别、宗教、信仰、性取向、性别认同、国籍、残疾、遗传信息、怀孕、退伍军人身份或任何其他受联邦、州或地方法律保护的特征而受到影响。