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.
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。