Financial Claims Coordinator- PMO

Job Description

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• Serve as the primary point of contact for claimants, clients, and internal stakeholders regarding claim inquiries and resolution.
• Receive, review, and process financial claims submitted by clients, customers, or third-party entities.
• Verify the accuracy and completeness of claim documentation and supporting evidence.
• Analyze claims to determine eligibility, coverage, and appropriate reimbursement amounts.
• Maintain organized records of all claims, correspondence, and related documentation
• Generate reports on claim status, trends, and outcomes as required by management or regulatory bodies.
• Communicate with insurance providers, healthcare professionals, legal counsel, and other relevant parties to gather information and facilitate claim resolution.
• Collaborate with cross-functional teams such as finance, legal, and customer service to address complex claims issues and ensure timely resolution.
• Conduct audits and quality checks on claims processing activities to identify errors, discrepancies, or potential fraud.
• Ensure adherence to company policies, procedures, and regulatory guidelines governing claims processing and reimbursement.
• Stay updated on changes in regulations, industry standards, and best practices related to financial claims management.
• Resolve disputes or conflicts related to claim decisions through effective negotiation and problem-solving skills.

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