Customer service representative

Job Summary

This hybrid role supports specialized insurance claims processing for workers compensation with a strong focus on customer service. The specialist will manage end to end claims activities collaborate with cross functional teams and ensure accurate and timely resolution. The role operates in rotational shifts and requires 2 to 3 years of relevant experience.

Responsibilities

• Manage workers compensation insurance claims from first notification through closure ensuring accurate documentation and timely resolution to support fair outcomes for all parties involved.
• Coordinate closely with policyholders claimants medical providers and internal teams to gather required information and clarify claim details in a clear professional manner.
• Evaluate claim information coverage terms and supporting documents to determine compensability and appropriate claim handling strategies aligned with company policies and regulatory expectations.
• Document all claim activities conversations and decisions in the claim management system with high levels of accuracy to support transparent claim histories and audit readiness.
• Communicate claim status next steps and expected timelines to customers and stakeholders with empathy and clarity reinforcing confidence in the service provided.
• Collaborate with medical case managers and external partners to review treatment plans return to work options and associated costs aiming to support worker recovery and cost effective outcomes.
• Analyze claim trends payment patterns and recurring issues to identify opportunities for process improvement and enhanced customer experience across the workers compensation portfolio.
• Adhere to all applicable workers compensation regulations and internal compliance guidelines ensuring consistent application of rules across all assigned claims.
• Respond promptly to customer service inquiries via phone email or digital channels resolving issues efficiently while maintaining a high standard of professionalism and courtesy.
• Utilize claim management tools and reporting dashboards to track workloads prioritize tasks and ensure service level agreements are consistently achieved.
• Support rotational shift coverage by maintaining flexibility in work hours and ensuring seamless handover of pending claims and tasks to colleagues for uninterrupted service.
• Participate in team meetings calibration sessions and knowledge sharing forums to stay updated on policy changes best practices and new product or process updates.
• Contribute to continuous improvement initiatives by sharing feedback from frontline claim handling experiences helping refine workflows and digital tools that benefit customers and society.

Qualifications

• Possess 2 to 3 years of hands on experience handling workers compensation insurance claims with direct responsibility for claim assessment documentation and resolution.
• Demonstrate strong customer service skills including active listening clear communication and the ability to manage difficult conversations with empathy and professionalism.
• Exhibit sound understanding of workers compensation principles claim lifecycle stages and typical roles of medical providers employers and regulators in the claim process.
• Show proficiency in using claim management systems and office productivity tools to record data prepare summaries and generate status updates for internal and external stakeholders.
• Apply basic analytical skills to interpret claim data identify inconsistencies and escalate potential risks or complex cases to senior claims professionals when needed.
• Display the ability to work effectively in a hybrid model environment balancing in office collaboration with remote work while maintaining productivity and service quality.
• Maintain adaptability for rotational shifts and demonstrate strong time management skills to handle multiple claims concurrently without compromising accuracy or service.

Certifications Required

Preferred certifications include Associate in Claims AIC or equivalent workers compensation or claims handling certification from a recognized insurance institute.

Over Cognizant  
Cognizant (NASDAQ: CTSH) is een bouwer van AI-oplossingen en een leverancier van technologiediensten. Wij slaan de brug tussen AI-investeringen en ondernemingswaarde door het bouwen van full-stack AI-oplossingen voor onze klanten. Onze diepgaande kennis van sectoren, processen en engineering stelt ons in staat om de unieke context van een organisatie te verankeren in technologische systemen. Deze systemen versterken het menselijk potentieel, realiseren tastbare resultaten en geven wereldwijde ondernemingen een voorsprong in een snel veranderende wereld. Ontdek hoe op cognizant.ai of @cognizant.

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