Claims Associate Representative (GHB) - PSO

YOUR JOB

Delivers administrative, technical, and operative tasks related to the processing, validation, and correction of partner claim data. Works with standardized reports, performs rule‑based 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 task‑by‑task 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 rule‑based 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, step‑by‑step procedures without deviation.
• Comfortable working in multiple internal systems.
• Basic Excel skills (sorting, filtering, adding columns, structuring tabs).
• Strong organizational skills with the ability to manage repetitive tasks efficiently.
• Proficient in Microsoft Office applications.
• English language skills required.
• Experience in administrative operations, data entry, or shared‑services roles is an advantage but not essential.
• Diploma or Degree required

KEY COMPETENCIES

• High attention to detail and accuracy when handling structured data tasks.
• Clear written and verbal communication with internal stakeholders.
• Ability to organize workload, prioritize tasks, and follow established processes.
• Strong problem‑solving within the limits of rule‑based parameters.
• Proactive in flagging issues, inconsistencies, or system errors.
• Ability to work independently with close supervision and clear instruction.

YOUR JOB

Delivers administrative, technical, and operative tasks related to the processing, validation, and correction of partner claim data. Works with standardized reports, performs rule‑based 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 task‑by‑task 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 rule‑based 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, step‑by‑step procedures without deviation.
• Comfortable working in multiple internal systems.
• Basic Excel skills (sorting, filtering, adding columns, structuring tabs).
• Strong organizational skills with the ability to manage repetitive tasks efficiently.
• Proficient in Microsoft Office applications.
• English language skills required.
• Experience in administrative operations, data entry, or shared‑services roles is an advantage but not essential.
• Diploma or Degree required

KEY COMPETENCIES

• High attention to detail and accuracy when handling structured data tasks.
• Clear written and verbal communication with internal stakeholders.
• Ability to organize workload, prioritize tasks, and follow established processes.
• Strong problem‑solving within the limits of rule‑based parameters.
• Proactive in flagging issues, inconsistencies, or system errors.
• Ability to work independently with close supervision and clear instruction.