045224-Claims Examiner

About Capgemini A global leader in consulting, technology services and digital transformation, Capgemini is at the forefront of innovation to address the entire breadth of clients� opportunities in the evolving world of cloud, digital and platforms. Building on its strong 50 year heritage and deep industry-specific expertise, Capgemini enables organizations to realize their business ambitions through an array of services from strategy to operations. Capgemini is driven by the conviction that the business value of technology comes from and through people. It is a multicultural company of over 200,000 team members in more than 40 countries. The Group reported 2018 global revenues of EUR 13.2 billion.
 

Visit us at www.capgemini.com. People matter, results count.    

                                                                                            

Capgemini is an Equal Opportunity Employer encouraging diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race, national origin, gender identity/expression, age, religion, disability, sexual orientation, genetics, veteran status, marital status or any other characteristic protected by law. 
This is a general description of the Duties, Responsibilities and Qualifications required for this position. Physical, mental, sensory or environmental demands may be referenced in an attempt to communicate the manner in which this position traditionally is performed. Whenever necessary to provide individuals with disabilities an equal employment opportunity, Capgemini will consider reasonable accommodations that might involve varying job requirements and/or changing the way this job is performed, provided that such accommodations do not pose an undue hardship. 

  

Click the following link for more information on your rights as an Applicant – http://www.capgemini.com/resources/equal-employment-opportunity-is-the-law

Summary

 

This job is responsible for providing quality and efficient customer service in an office environment.  Additional responsibilities include assisting manager with development, analysis and implementation of staffing training.

 

Essential Duties and Responsibilities include the following.

 

Ensure  claims are adjudicated as per the guidelines of the company. Provide continual evaluation of processes and procedures.  Responsible for suggesting methods to improve area operations, efficiency and service to both internal and external customers.

Provide statistical and performance feedback and coaching on a regular basis to each team member.  Write and administer performance reviews for skill improvement.

Provide support for fellow team members by providing appropriate coaching, counseling, direction and resolution.

 

Ensure fellow employees have appropriate training and other resources to perform their job. 

 

Respond to and resolve customer issues. 

 

Assist manager with daily operation of claims processing to include development, analysis  and implementation of staffing and training.

Work as a member/leader of special or on-going projects that are important to area/process improvement.

Share continual responsibility and ensuring calls are handled efficiently and effectively.

Establish work procedures and processes that support company and departmental standards, procedures and strategic directives.

Communicate with upper management regarding department or employee concerns.

Complying with company regulations regarding HIPAA, confidentiality, and private health information.

 

 

Qualifications:

 

To perform these jobs successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Excellent oral, written and interpersonal communication skills

Knowledge of Microsoft Office applications and telephone protocol

Exceptional listening and analytical skills

Strong knowledge of customer care processes and techniques

Demonstrated ability to work well in a team environment

Dedication to providing exceptional customer service

Proven leadership experience

 

Ability to provide and support company goals.

Education and/or Experience

 

One year certificate from college or technical school; or one year to 18 months related experience and/or training; or equivalent combination of education and experience; BA preferred

Excellent communication skills both verbal and written are required.

Working knowledge of Inspro, AS400, Capsil, and Cisco is preferred.

 

Language Skills

 

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals.  Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

 

 

Mathematical Skills

 

Ability to calculate figures and amounts such as discounts, interest, and percentages.  Ability to apply concepts of basic algebra.

 

Reasoning Ability

 

 

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Physical Demands

 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Work Environment

 

 

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Candidates should be flexible / willing to work across this delivery landscape which includes and not limited to Agile Applications Development, Support and Deployment.

Ref:

045224

Posted on:

August 13, 2019

Experience level:

Experienced (Non Manager)

Education level:

Bachelor's Degree (�16 years)

Contract type:

Regular

Location:

Pensacola

Department:

US072627

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