Delivers administrative, technical, and operative tasks related to the processing, validation, and correction of partner claim data. Works with standardized reports, performs rulebased corrections in policy administration system, raises IT tickets where required, and supports the accuracy of automated data feeds. Understands and applies simple instructions and procedures. Work is allocated on a daily or taskbytask basis with clear direction. This role is an entry point into administrative operations.
What are your main Duties/Responsibilities:
Run, prepare, and categorize the weekly reports, including sorting lines by error code and updating BAU trackers.
Correct basic data issues in the policy administration system (e.g., member numbers, procedure codes, diagnosis codes, service dates, partner IDs, net/billed amounts) using defined SOP steps and system prompts.
Follow rulebased instructions for each error category, applying fixes or routing items to IT when required.
Escalate to Supervisor and raise IT tickets for duplicate closures, forced claim loads, invalid data corrections, or adjustments that cannot be resolved directly.
Work on adjustment and reconciliation reports, documenting claim numbers, preparing tracking sheets, and reprocessing or reversing claims following predefined procedures.
Mailbox ownership and handling of the escalated cases within the TAT´s.
Maintain accurate documentation, add standard claim comments, and ensure reports and logs are correctly archived per SOP.
Identify and report to Supervisor continuous improvement opportunities - Mapping, reporting, processes.
Carry out other administrative tasks as required to support business needs.
YOUR PROFILE
Excellent attention to detail with a strong focus on accuracy and data integrity.
Ability to follow structured, stepbystep procedures without deviation.