Claims Associate Representative (GHB) – PSO

This entry-level administrative role involves performing technical and operational tasks related to the processing, validation, and correction of partner claim data. The associate will work with standardized reports, apply rule-based corrections within the policy administration system, and raise IT tickets as needed to ensure the accuracy of automated data feeds. The position requires understanding and applying simple instructions and procedures, with daily or task-specific work allocated under clear direction.

1. Prepare, run, and categorize weekly reports, including sorting by error code and updating business-as-usual trackers.
2. Correct fundamental data issues in the policy administration system, such as member numbers, procedure codes, diagnosis codes, service dates, partner IDs, and net/billed amounts, following defined standard operating procedures and system prompts.
3. Implement rule-based instructions for various error categories, applying necessary fixes or escalating items to IT when required.
4. Escalate unresolved issues to the Supervisor and create IT tickets for situations like duplicate closures, forced claim loads, invalid data corrections, or adjustments.
5. Manage adjustment and reconciliation reports by documenting claim numbers, preparing tracking sheets, and processing or reversing claims according to established procedures.
6. Take ownership of the team mailbox and handle escalated cases within specified turnaround times.
7. Maintain precise documentation, add standard claim comments, and ensure all reports and logs are properly archived as per SOP.
8. Identify and report opportunities for continuous improvement in mapping, reporting, and processes to the Supervisor.
9. Perform additional administrative duties as required to support business objectives.

1. Demonstrated excellent attention to detail with a strong emphasis on accuracy and data integrity.
2. Capability to adhere strictly to structured, step-by-step procedures.
3. Comfortable navigating and working within multiple internal systems.
4. Basic proficiency in Excel, including sorting, filtering, adding columns, and structuring tabs.
5. Strong organizational skills to efficiently manage repetitive tasks.
6. Competence in Microsoft Office applications.
7. Required English language proficiency.
8. Prior experience in administrative operations, data entry, or shared-services roles is beneficial but not mandatory.
9. Hold a Diploma or Bachelor's Degree.
10. Possess high attention to detail and accuracy when handling structured data.
11. Exhibit clear written and verbal communication skills for internal stakeholders.
12. Ability to organize workload, prioritize tasks, and follow established processes.
13. Strong problem-solving abilities within defined rule-based parameters.
14. Proactive in identifying and reporting issues, inconsistencies, or system errors.
15. Capable of working independently with close supervision and clear instructions.