Job Summary
Role SPE Ins Claims requires an experienced claims specialist to handle workers compensation insurance claims while delivering high quality customer service in a hybrid work model. The role focuses on efficient claims handling accurate documentation empathetic support and effective communication in Spanish for a diverse claimant base within rotational shifts.
Responsibilities
- Manage end to end workers compensation claims processes by gathering relevant information from claimants employers and medical providers to ensure timely and accurate claim resolution
- Handle complex claim inquiries through customer service channels by actively listening clarifying needs and providing clear guidance to claimants and stakeholders to improve satisfaction and trust
- Coordinate with internal claims teams adjusters and operations staff to streamline case handling steps and reduce processing delays while maintaining compliance with company policies and regulatory requirements
- Document all claim related interactions assessments and decisions in the claims system with high attention to detail to support audit readiness and transparent claims histories
- Communicate fluently in Spanish across read write and speak capabilities to support claimants and stakeholders who prefer Spanish language interactions and to reduce communication barriers
- Respond empathetically and professionally to injured workers employers and medical partners in stressful situations and provide clear explanations of claim status benefits and next steps to foster confidence
- Escalate unusual or high risk claims scenarios to senior specialists or supervisors following defined protocols to protect the company from potential exposure while ensuring fair treatment of claimants
- Analyze claim information medical reports and employment records to identify patterns and potential issues and then recommend appropriate actions that support accurate benefits determination
- Collaborate with cross functional partners such as legal compliance and medical review teams to resolve claim discrepancies and ensure decisions follow applicable workers compensation rules in relevant jurisdictions
- Utilize customer service best practices including structured call handling clear written communication and effective follow up to decrease repeat contacts and improve first contact resolution rates
- Adapt to rotational shifts in a hybrid work environment while maintaining consistent availability responsiveness and productivity in both remote and office settings
- Monitor personal workload using company tools to prioritize tasks for timely completion of claim reviews outreach activities and documentation updates in alignment with service level expectations
- Contribute to continuous improvement efforts by sharing insights from claim interactions and suggesting practical enhancements to workflows communication materials or training content that benefit claimants and the organization
Qualifications
- Demonstrate solid experience in workers compensation claims handling over at least two years by managing claim files using structured processes and applying relevant regulatory and policy guidelines
- Exhibit strong customer service skills through prior roles that involved direct interaction with clients or claimants and show ability to resolve concerns with patience clarity and professionalism
- Communicate effectively in Spanish across reading writing and speaking to manage claim discussions documentation and follow ups with stakeholders who require or prefer Spanish language support
- Apply basic analytical and problem solving skills to interpret claim details policy information and medical documentation and then make grounded recommendations for next actions
- Work reliably in a hybrid model by using collaboration tools and claims platforms in both remote and office settings while maintaining data confidentiality and productivity standards
- Operate comfortably in rotational shifts and adjust personal routines as needed to be consistently available during assigned hours which supports team coverage and claimant access
- Show familiarity with insurance or claims management systems and common productivity tools allowing quick navigation documentation and retrieval of claim information during daily activities
Certifications Required
Preferred certification in claims or insurance such as Associate in Claims AIC or equivalent
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
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