Job Summary
This hybrid day shift specialist role focuses on handling workers compensation insurance claims while delivering high quality customer service in Spanish and English. The specialist manages end to end claim processing supports injured workers and employer clients and ensures accurate documentation and resolution in line with regulatory and company standards for fair and timely claim outcomes.
Responsibilities
- Manage workers compensation claims from initial intake through closure by capturing detailed incident information and ensuring accurate claim setup in internal systems for timely and compliant processing.
- Handle inbound and outbound customer interactions in Spanish and English by actively listening to injured workers and employer contacts and providing clear information on claim status benefits and next steps.
- Assess claim documentation such as injury reports medical notes and wage statements by verifying completeness and consistency to support fair benefit determination according to company policies and regulatory requirements.
- Coordinate with medical providers employers and internal teams by gathering relevant information and resolving discrepancies to maintain a coherent and up to date claim file that supports efficient decisions.
- Explain workers compensation benefits coverage limitations and procedural steps by using accessible language so claimants and employers clearly understand their rights obligations and available support.
- Monitor claim progress against service level targets by tracking tasks follow ups and outstanding documents to minimize delays and improve overall claim resolution timelines.
- Identify potential claim issues such as incomplete information inconsistent narratives or possible fraud indicators by escalating complex cases to senior claims specialists for further review and guidance.
- Document each customer interaction and decision point comprehensively in claim systems by following standardized formats to ensure accurate records and support audits and quality reviews.
- Collaborate with customer service colleagues and claims peers in a hybrid work model by sharing insights and best practices that enhance claim handling consistency and customer satisfaction.
- Apply problem solving techniques to address claimant and employer concerns by proposing practical solutions that balance customer needs with compliance and cost effectiveness for the organization.
- Adhere to regulatory and company standards for workers compensation claims by staying current with policy updates and procedural changes to reduce errors and safeguard organizational integrity.
- Utilize digital tools and internal applications efficiently by navigating claim screens and knowledge resources to quickly locate information and deliver responsive service during each customer contact.
- Contribute to continuous improvement by providing feedback on recurring customer pain points and process gaps that can inform enhancements to workflows guidance and training materials.
Qualifications
- Demonstrate proven experience of two to three years in customer service environments handling complex inquiries and resolving issues with empathy accuracy and timely follow through.
- Show solid hands on exposure to workers compensation claims operations including intake investigation documentation and benefit explanation across multiple case types and scenarios.
- Communicate fluently in Spanish and English for reading writing and speaking by adapting tone and clarity to diverse customer backgrounds while maintaining professionalism and respect.
- Apply strong analytical skills when reviewing claim information by identifying missing elements inconsistencies and potential risks that could affect entitlement or payment decisions.
- Use established case management or claims systems confidently by entering updating and retrieving data with high attention to detail to limit processing errors and rework.
- Demonstrate knowledge of basic regulatory concepts relevant to workers compensation including common timelines documentation expectations and claimant protections.
- Exhibit resilience and emotional maturity when managing conversations with individuals experiencing workplace injuries or financial stress by remaining calm patient and solutions focused.
Certifications Required
Preferred certification in claims handling or insurance such as Workers Compensation Claims Professional or equivalent customer service training
Über Cognizant
Cognizant (NASDAQ: CTSH) i ist ein Technologiedienstleister und Entwickler von KI-Lösungen. Wir schlagen die Brücke zwischen KI-Investitionen und echtem unternehmerischem Mehrwert, indem wir ganzheitliche Full-Stack-KI-Lösungen für unsere Kunden entwickeln. Mit unserer fundierten Branchen-, Prozess- und Engineering-Expertise integrieren wir die spezifischen Anforderungen von Unternehmen passgenau in Technologiesysteme. So entfalten wir das menschliche Potenzial, erzielen greifbare Ergebnisse und sichern globalen Unternehmen in einer sich rasant wandelnden Welt den entscheidenden Vorsprung. Erfahren Sie mehr unter cognizant.ai oder @cognizant.
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