SENIOR CLAIMS ANALYST

Description

Job Summary: Responsible for conducting investigations, preparing technical opinions, organizing documentation, and optimizing processes for internal and external customers. Key Highlights: 1. Conduct investigations and prepare medium-complexity technical opinions. 2. Maintain systems up to date and contribute to operational efficiency. 3. Interact with customers, internal departments, and third-party service providers. Responsible for conducting medium-complexity investigations, preparing technical opinions, and ensuring proper organization and verification of documentation. Prepares reports, clarifies doubts with customers and internal departments, maintains the system updated, and contributes improvement suggestions to enhance operational efficiency Request investigations via phone interviews, document analysis, and formulation of relevant questions regarding the incident; Monitor and follow up on investigation report submissions from third-party service providers; Analyze investigations and prepare medium-complexity technical opinions; Verify documentation registered in the system, analyzing causal relationship, motivation, and effects of the incident; Investigate processes carefully, referring incidents to third-party companies (e.g., investigations, technical appraisals, etc.) when necessary; Request additional analysis of causal relationship from investigators, where applicable; Forward cases to the fraud prevention department upon identifying indications of fraud; Resolve inquiries from members and internal departments; Complete analysis checklists, verifying documents and requesting pending items; Review administrative tasks and adjust terms as needed; Update and maintain the system with case progress information; Monitor operational deadlines, including sending closure letters; Correct documents prepared by administrative staff, when necessary; Serve employees and members with a focus on quality and resolution; Support team requests and interact with other organizational departments; Report activity progress to the manager and proactively deliver assigned tasks; Pursue continuous learning and suggest process improvements; Perform other duties related to this position.