The role involves generating daily reports on pending claims processes using the ELITA database to meet regulatory needs
Job Summary
The role involves generating daily reports on pending claims processes using the ELITA database to meet regulatory needs.
Candidates must analyze claims against internal procedures, verifying policy conditions, validity, documentation, and budgets before approval or rejection.
The position requires conducting negotiations for complaints, identifying root causes, and implementing measures to resolve issues while maintaining low complaint levels.
Matching Summary
The role involves generating daily reports on pending claims processes using the ELITA database to meet regulatory needs.
Skills & Requirements
Must-have
ELITA database proficiency
claims process analysis
contractual condition verification
fraud detection and reporting
regulatory compliance knowledge
Nice-to-have
strong negotiation skills
critical case evaluation
stakeholder communication
process improvement suggestions
Key Requirements
Senior level experience in claims processing
Ability to approve or reject claims within delegated authority
Experience with audit and fraud certification processes