Claim Representative

Senior Claims Analyst / Claims Team Lead (Remote)

Summary

An experienced claims professional is sought to support an international claims operation. The role focuses on accurate and timely processing of U.S. and international healthcare claims, supporting quality standards, resolving complex cases, and contributing to process improvements. Senior candidates may also provide team leadership and coaching.

Key Responsibilities

• Review, analyse, and adjudicate U.S. and international medical claims in line with payer requirements and SLAs.
• Handle complex claims, escalations, and benefit or pricing validations.
• Liaise with PPO networks and healthcare providers to resolve claim issues.
• Ensure compliance with policy terms, billing codes, and regulatory standards.
• Support process optimisation, automation, and efficiency initiatives.
• Collaborate with internal teams such as...