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.
Sobre a Cognizant
Cognizant (NASDAQ: CTSH) é uma construtora de IA e fornecedora de serviços de tecnologia, criando a ponte entre o investimento em IA e o valor para as empresas por meio do desenvolvimento de soluções de IA completas para nossos clientes. Nossa profunda experiência em setores, processos e engenharia nos permite incorporar o contexto único de cada organização em sistemas tecnológicos que potencializam a capacidade humana, geram resultados tangíveis e mantêm empresas globais à frente em um mundo em rápida transformação. Saiba mais em cognizant.ai ou @cognizant.
A Cognizant é uma empregadora que investe em equidade. Sua candidatura não será pautada em raça, cor, gênero, sexualidade, credo, origem, deficiência, gravidez ou qualquer outra característica protegida pelas leis brasileiras.
Informações adicionais de emprego
Os candidatos podem ser obrigados a comparecer a entrevistas presenciais ou por videoconferência. Além disso, os candidatos podem ser obrigados a apresentar seu documento de identificação emitido pelo estado ou governo atual durante cada entrevista.
Embora nosso sistema permita a candidatura em todos os idiomas, o(s) idioma(s) e o(s) nível(is) de proficiência exigidos para o trabalho variam. No entanto, é necessário um nível básico de inglês para fins de comunicação em toda a empresa.
A Cognizant é uma empregadora que investe em equidade. Sua candidatura não será pautada em raça, cor, gênero, sexualidade, credo, origem, deficiência, gravidez ou qualquer outra característica protegida pelas leis brasileiras.
Se você tem uma deficiência que requer adaptações razoáveis para procurar uma vaga de emprego ou enviar uma candidatura, envie um e-mail para [email protected] com sua solicitação e informações de contato.