Job Summary

Responsible for Retail or Package Product claims processing by determining the validity of claims, identifying the need for further investigation, and following claims through settlement in accordance with claims processing guidelines to achieve productivity and service commitments.

Key Responsibilities

1. Review Retail or Package Product claim cases to determine validity and verify coverage within assigned authority; identify the need for further investigation and subsequently settle claims through acceptance or denial of payment in accordance with claims processing guidelines and contract provisions to ensure accuracy of claim settlements.
2. Prepare over-authority claim cases for submission to superiors for review and approval.
3. Review pending cases and liaise with medical providers and relevant parties to obtain information neces...