Job Summary
Serve as a specialist in insurance claims handling within workers compensation focusing on accurate and empathetic customer service for diverse claimants and stakeholders. Manage end to end claim activities in a hybrid work model with rotational shifts using Spanish and English language skills to support inclusive and equitable access to claim services while maintaining compliance and service quality.
Responsibilities
- Handle end to end workers compensation claims from first notice of loss through closure ensuring timely and accurate claim setup investigation and resolution for every assigned file.
- Coordinate proactively with claimants employers health care providers and internal teams to gather required information and resolve open issues that can impact claim outcomes.
- Review medical reports wage statements and accident details carefully to validate coverage determine compensability and document clear rationales for every decision in the claim system.
- Communicate claim status next steps and decisions in a clear and empathetic manner in both English and Spanish ensuring that every party understands their rights obligations and available options.
- Apply jurisdictional workers compensation rules policy terms and internal guidelines consistently to calculate benefits recommend payments and manage reserves with strong attention to detail.
- Collaborate with supervisors legal resources and clinical specialists as needed to address complex or contested claims while maintaining focus on fair outcomes and cost effectiveness.
- Use customer service techniques such as active listening de escalation and solution focused dialogue to manage difficult conversations and support individuals experiencing workplace injury related stress.
- Document every interaction and decision thoroughly in the claim management system ensuring accurate audit ready records and reliable data for reporting and continuous improvement.
- Identify patterns and potential risks within a portfolio of claims and share timely insights that can help reduce workplace injuries improve recovery outcomes and optimize claim handling practices.
- Adapt workload and priorities effectively within a hybrid and rotational shift environment maintaining consistent service levels and responsiveness across time zones and work locations.
- Utilize digital tools telephonic channels and secure online platforms to deliver convenient and accessible claim related support while protecting sensitive personal information.
- Support team initiatives that enhance customer experience such as improving scripts refining workflows and contributing to knowledge bases that assist colleagues and new joiners.
- Participate actively in training coaching and quality review sessions to strengthen technical insurance knowledge reinforce customer service behaviors and align with evolving regulatory expectations.
Qualifications
- Possess at least 2 years of Customer Service experience.
- Display adaptability and reliability in a hybrid and rotational shift model maintaining punctual attendance consistent follow through and effective time management across varying schedules.
- Demonstrate strong customer service capabilities through prior roles involving direct interaction with customers resolution of sensitive issues and management of high volume inquiries.
Maintain experience in workers compensation claims handling demonstrating practical understanding of claim lifecycles benefit types and injury documentation requirements.
- Show proficiency in Spanish reading writing and speaking enabling effective support for Spanish speaking claimants and employers in a professional insurance context.
- Apply knowledge of basic medical terminology wage replacement concepts and workplace safety principles in a descriptive and understandable way during claim reviews and customer interactions.
- Utilize computer literacy and familiarity with claim management or case management systems to navigate complex screens enter accurate data and retrieve information quickly during calls.
Exhibit problem solving skills and analytical thinking when comparing medical findings policy coverage details and legal requirements to arrive at fair claim decisions.
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.
Aanvullende arbeidsinformatie
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