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.
À propos de Cognizant
Cognizant (NASDAQ : CTSH) est un AI Builder et une entreprise de services numériques (ESN) élaborant des solutions complètes d’IA maximisant les investissements pour des résultats concrets. Sa profonde expertise des métiers, des processus et des technologies lui permet d’intégrer dans les systèmes technologiques le contexte unique de chaque organisation de l’ingénierie à la production à l’échelle. Son objectif : améliorer l’efficacité des équipes, créer de la valeur et permettre aux grandes entreprises de rester performantes dans un monde qui évolue rapidement. Pour en savoir plus : cognizant.ai ou @cognizant.
Renseignments suppplémentaires sur l'emploi
Les informations relatives à la rémunération du poste à pourvoir dépendent de la date de publication de l’offre de poste. Cognizant se réserve le droit de modifier ces informations à tout moment, sous réserve des lois applicables.
Cognizant est un employeur soucieux de l'égalité des chances entre candidats. Votre candidature sera étudiée indépendamment de votre race, couleur, sexe, religion, croyances, orientation sexuelle, identité de genre, origine, handicap, informations génétiques, grossesse, statut d'ancien militaire ou de toute autre critère jugé discriminant par les lois européennes ou françaises.
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