Insurance Claim Verification Specialist
This role is responsible for protecting the integrity of the claims process while ensuring a fair, respectful, and positive experience for all individuals involved. By carefully reviewing and validating claims, the role helps prevent fraudulent activity while ensuring that legitimate claims are handled with accuracy, efficiency, and care.
The position works closely with internal teams and supports claimants by promoting clear communication, timely resolution, and consistent adherence to policies, helping build trust and confidence in the claims process.
Job specifics
-External Contractor (90-day probation period, with eligibility to transition to a local contract upon successful completion)
-In office
-Salary DOP$39,000 (Monthly)
- Plus Transportation Allowance DOP$5000 (Monthly)
-Schedule 08:30AM ? 05:00PM (AST) ? Daylight Savings 09:30AM ? 6:00PM (AST)
-US and Local Holiday work ? Upon client?s request.
Job Responsibilities:
* Claims Review: Examine insurance claims for completeness, accuracy, and required documentation.
* Verification: Validate claim details against policy information and confirm the authenticity of submitted documents through communication with policyholders, providers, and other parties.
* Communication: Interact with claimants and relevant stakeholders to request clarification, provide claim status updates, and explain next steps.
* Fraud Prevention: Identify inconsistencies or patterns indicating potential fraud and escalate suspicious claims for further review.
* Documentation & Compliance: Maintain accurate records, document claim decisions, and ensure adherence to company policies and regulatory requirements.
* Confidentiality & Technology: Safeguard sensitive information while using claims systems, tools, and data analysis to support efficient and accurate processing.
Requirements for the role:
-English level: B2+
-Excellent Writing skills.
-Insurance Industry experience is a Plus.
-High Attention to detail
-Strong organizational skills
-Comfortable working in a fast-paced environment