Claims Representative

The role involves providing high-quality Tier 2 customer support through inbound calls, emails and chats, with a strong focus on issue resolution, customer satisfaction and adherence to defined service standards. The selected candidates will assist customers with their queries, provide appropriate guidance, accurately document customer interactions and escalate unresolved issues to the relevant internal teams. Process health insurance claims accurately and within defined timelines. Review claim information, member details, and supporting documents for completeness and accuracy. Validate claim details against applicable health insurance policies and process guidelines . Identify missing, incorrect, or inconsistent information and take appropriate action. Update and maintain accurate claim information in the relevant systems. Perform basic research and follow established procedures for claim processing. Handle claim-related queries and provide appropriate information as per process guidelines.