Job Summary
Serve as a specialist in insurance claims handling within workers compensation focusing on accurate and empathetic customer service for diverse claimants and stakeholders. Manage end to end claim activities in a hybrid work model with rotational shifts using Spanish and English language skills to support inclusive and equitable access to claim services while maintaining compliance and service quality.
Responsibilities
- Handle end to end workers compensation claims from first notice of loss through closure ensuring timely and accurate claim setup investigation and resolution for every assigned file.
- Coordinate proactively with claimants employers health care providers and internal teams to gather required information and resolve open issues that can impact claim outcomes.
- Review medical reports wage statements and accident details carefully to validate coverage determine compensability and document clear rationales for every decision in the claim system.
- Communicate claim status next steps and decisions in a clear and empathetic manner in both English and Spanish ensuring that every party understands their rights obligations and available options.
- Apply jurisdictional workers compensation rules policy terms and internal guidelines consistently to calculate benefits recommend payments and manage reserves with strong attention to detail.
- Collaborate with supervisors legal resources and clinical specialists as needed to address complex or contested claims while maintaining focus on fair outcomes and cost effectiveness.
- Use customer service techniques such as active listening de escalation and solution focused dialogue to manage difficult conversations and support individuals experiencing workplace injury related stress.
- Document every interaction and decision thoroughly in the claim management system ensuring accurate audit ready records and reliable data for reporting and continuous improvement.
- Identify patterns and potential risks within a portfolio of claims and share timely insights that can help reduce workplace injuries improve recovery outcomes and optimize claim handling practices.
- Adapt workload and priorities effectively within a hybrid and rotational shift environment maintaining consistent service levels and responsiveness across time zones and work locations.
- Utilize digital tools telephonic channels and secure online platforms to deliver convenient and accessible claim related support while protecting sensitive personal information.
- Support team initiatives that enhance customer experience such as improving scripts refining workflows and contributing to knowledge bases that assist colleagues and new joiners.
- Participate actively in training coaching and quality review sessions to strengthen technical insurance knowledge reinforce customer service behaviors and align with evolving regulatory expectations.
Qualifications
- Possess at least 2 years of Customer Service experience.
- Display adaptability and reliability in a hybrid and rotational shift model maintaining punctual attendance consistent follow through and effective time management across varying schedules.
- Demonstrate strong customer service capabilities through prior roles involving direct interaction with customers resolution of sensitive issues and management of high volume inquiries.
Maintain experience in workers compensation claims handling demonstrating practical understanding of claim lifecycles benefit types and injury documentation requirements.
- Show proficiency in Spanish reading writing and speaking enabling effective support for Spanish speaking claimants and employers in a professional insurance context.
- Apply knowledge of basic medical terminology wage replacement concepts and workplace safety principles in a descriptive and understandable way during claim reviews and customer interactions.
- Utilize computer literacy and familiarity with claim management or case management systems to navigate complex screens enter accurate data and retrieve information quickly during calls.
Exhibit problem solving skills and analytical thinking when comparing medical findings policy coverage details and legal requirements to arrive at fair claim decisions.
コグニザントについて
コグニザント（NASDAQ: CTSH）は、AI Builderおよびテクノロジーサービスプロバイダーとして、お客様にフルスタックのAIソリューションを構築することで、AI投資と企業価値を結ぶ架け橋となっています。業界、ビジネスプロセス、エンジニアリングに関する当社の深い専門知識を活かし、組織固有のビジネス環境をテクノロジー・システムに組み込みます。これにより、人間の可能性を最大限に引き出し、確かな成果を実現するとともに、急速に変化する世界においてグローバル企業が常に一歩先を行くための支援を行っています。 詳細については、cognizant.ai をご覧ください。
雇用に関する追加情報
本募集に記載されている報酬情報は、掲載日時点で正確なものです。Cognizantは、適用される法令に従い、いつでも本情報を変更する権利を留保します。
応募者は、対面またはビデオ会議による面接への参加を求められる場合があります。また、各面接の際に、現在有効な州政府または政府発行の身分証明書の提示を求められる場合があります。
Cognizantは機会均等雇用主です。応募および選考において、人種、肌の色、性別、宗教、信条、性的指向、性自認、国籍、障がい、遺伝情報、妊娠、退役軍人の地位、その他連邦法・州法・地方自治体の法律により保護されるいかなる特性に基づく差別も行いません。