• To analyze mid- and higher-level general auto claims to determine scope of damages. • To ensure ongoing adjudication of claims within company standards and industry best practices. • To identify subrogation of claims and negotiate settlements. • Manages mid-level and higher-level auto commercial and personal lines claims by gathering information to determine exposure. • Assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level. • Assesses liability and resolves claims within evaluation. • Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract. • Manages subrogation of claims and negotiates settlements. • Communicates claim action with claimant and client. • Ensures claim files are properly documented and claims coding is correct. • Maintains professional client relationships.

• Reports directly to the unit Claims Supervisor • Provide technical backup in the absence of the Claims Supervisor • Manage an assigned inventory of claim files • Perform a three-point contact on all new losses • Document ongoing case facts and information for compensability • Ensure up to date plan of action for indemnity claims • Partner with medical case manager for early return to work • Refer cases with suspected fraud to SIU • Pursue subrogation from culpable third parties • Review and approve all vocational rehabilitation plans • Monitor and adjust monetary case reserves • Review medical bills for appropriateness prior to payment referral • Maintain a courteous and helpful attitude and project a professional image

Role Description Remote Recruitment is hiring a Claims Handler for our UK-based clients. This is a fully remote position offering South African professionals an excellent opportunity to work with leading UK employers from home. You will work UK business hours and join a supportive, fast-growing team. - Receive, log and assess incoming insurance or warranty claims from customers - Verify supporting documentation and investigate validity of each claim - Communicate clearly and empathetically with claimants throughout the process - Authorise and process approved settlements accurately within agreed timeframes - Identify fraudulent or suspicious claims and escalate appropriately - Maintain accurate and compliant claims records in line with regulatory requirements Qualifications - 2+ years of claims handling, insurance or warranty experience - Strong analytical skills with ability to interpret complex documentation - Excellent verbal and written communication and customer service skills - Knowledge of insurance or warranty claims processes and relevant regulations - High attention to detail and ability to work independently from home Benefits - R26,000/month - 100% remote, UK business hours - Career growth and professional development - Exposure to leading UK businesses and practices Company Description Remote Recruitment – connecting top South African talent with UK employers. Apply today.

Claims Representative - Remote Location: Remote - USA Category: Customer Service & Claims Job Id: 26007462 Job Description: SUMMARY The claims representative is responsible for manually reviewing and processing medical, supplemental, or dental claims. Claims are processed according to benefits, eligibility, and internal processes, policies, and procedures and may be completed, held for additional information/review, or denied. New claim representatives will be provided with a robust training program, which includes virtual classroom training, on-the-job learning/feedback, and gradually increasing claims per hour/quality requirements over several months. After completion of training, claim representatives must meet specific accuracy/quality, volume/claims per hour, and on production performance metrics. $19/Hour Pay Rate RESPONSIBILITIES · Independently research and navigate various documents and databases to accurately process claims, ensuring compliance and adherence to established guidelines. · Confirm the presence of necessary documents within submitted claims. · Validate the accuracy of medical codes provided in claim submissions. · Assess the eligibility status of claims based on established criteria. · Review and verify other insurance coverage information in submitted claim. · Evaluate authorizations provided in claim submissions for accuracy. · Analyze account benefit plans to ensure claims align with coverage and policies. · Identify discrepancies, errors, or missing information. · Utilize multiple computer applications simultaneously. · Maintain self-discipline, consistently uphold a strong work ethic, and complete work tasks/responsibilities while working without close supervision. · Meet or exceed quality and productivity goals. · Identify claim processing learning opportunities by working directly with supervisors, coaches, and trainers to learn efficient and effective processing techniques and workflows. · Utilize a variety of virtual tools, including Outlook email, Cisco Webex, and similar applications, to effectively collaborate, communicate, and stay connected with colleagues and supervisors. QUALIFICATIONS · High school diploma or equivalent · Ability to quickly learn a variety of computer applications to complete job functions, · Experience sending/receiving emails, scheduling calendar appointments/sending invitations, attaching files in Microsoft Outlook. · Knowledge of basic Microsoft Excel functions, such as filtering/sorting. · Experience in navigating multiple computer applications through the use of shortcut keys and other techniques. · Detail-oriented with experience in applying complex policy/procedure documents. · Strong organizational skills to maximize available work time. Ability to prioritize tasks to ensure job tasks are completed before deadlines. · Proven experience completing work with quality and productivity performance standards. · Experience working independently in a virtual environment preferred. · Experience with medical and insurance terminology in a professional setting preferred. · Knowledge of CPT/ICD-10 codes preferred. · Proven experience in health insurance claims processing or similar field preferred If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an hourly rate of 17.75 - 26 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.