Claims Resolution Specialist

Claims Resolution Specialist ~ Remote

Virtual, USA

Overview

The Claims Resolution Specialist is responsible for validating and clearing claims against promotional offers, analyzing claims to determine their validity, and clearing claims in accordance with Acosta, client and customer policies and procedures. The Claims Resolution Specialist will communicate with internal and external business partners and act as a problem solver/agent for change to provide high quality service to clients and make continuous improvements in claims processing.

This is a remote position, work from home anywhere in the United States.

#remote

Responsibilities

• Trains and mentors Claims associates on validating and clearing claims in accordance with Acosta, client and customer policies and procedures.
• Assumes supervisory responsibilities in the absence of the Claims Resolution Supervisor
• Assists the Claims Resolution Supervisor by assuming additional responsibilities as needed
• Processes claims for key complex customers and assists in onboarding new clients
• Uses advanced problem solving and analytical skills to research problem claims and assess the reason they cannot be completed
• Works with Claims Resolution Analysts, sales, clients, customers and the management team to identify the root cause and resolve claims issues to increase quality, efficiency and prevent future errors
• Maintains a high level of proficiency in Acosta, client and customer systems, policies and procedures for assigned clients and adheres to them when processing claims
• Makes the final decision on claims validity for assigned claims
• Clears valid claims correctly and in accordance with Acosta and client policies and procedures
• Processes invalid claims in accordance with Acosta, client and customer policies and procedures
• Meets or exceeds Acosta and client financial goals
• Uses systems, reports, job aids, and Standard Operating Procedures to insure assigned claims meet or exceed Acosta and client quality metrics
• Achieves a level of productivity that meets or exceeds expectation
• Processes claims in the priority order established by the management team
• Insures that assigned claims are supported by financially compliant documentation
• Reports quality issues with assigned claims and provides training support to correct them
• Proactively manages work to meet client and customer deadlines
• Communicates with internal and external customers and clients on a regular basis to build relationships and provide value added services and solutions
• Asks for assistance from the management team on issues with complex claims, claims associates, clients and internal/external customers
• Follows Standard Operating Procedures and keeps them updated
• Reconciles our records with the client’s to ensure that all assigned claims are entered and in process
• Recognizes, reports and provides solutions for operational obstacles that delay work completion
• Recommends system, process and procedure enhancements to Acosta management and clients to improve results
• Other duties as assigned

Qualifications

• Four years claims experience preferred
• Food brokerage experience and/or clients’ experience in sales administration is strongly preferred
• Relationship management experience preferred
• Accepts accountability for job performance; proactively informs others problems that limit the ability to meet expectations
• Accepts change as a normal part of doing business, maintains a positive attitude and exhibits constructive work behaviors during periods of transition
• Meets work and attendance expectations; informs others in advance when commitments cannot be fulfilled
• Actively supports organizational goals and values; aligns actions around organizational goals; gives priority to organizational needs and concerns when making decisions
• Takes a reasoned logical approach in making judgments and decisions, carefully reviews available facts and information before reaching any conclusions
• Identifies and gathers relevant information, consults the right people and asks the right questions in a given situation
• Demonstrates disciplined thinking that is clear, unbiased, analytical and informed by evidence
• Effectively communicates with others
• Must be able to operate a calculator, computer, printer, fax machine, telephone, copier and shredder
• Must be proficient in excel and Microsoft Office

Acosta Sales & Marketing is an Equal Opportunity Employer

By submitting your application you agree with and accept the Acosta Privacy Statement and Terms of Conditions.

Acosta utilizes E-Verify for validating the ability to work in the United States for all job candidates. If you want more information on what this entails and your rights as a job applicant, please use the link provided to access information on our use of E-Verify and your right to work. Employer Resources (e-verify.gov)

Work State US-Multiple Locations

Job ID 2023-224240

Work City United States

PCN 127370

Position Type Regular Full-Time

Work Zip 00000

Starting average hours per week 37.5 +

Category Corporate Jobs