Job Description

This position coordinates timely insurance submission applications and supports the department and the Wellforce Insurance Director or its equivalent role on all statistical and budgetary matters involving risk management and insurance operations.  The position inputs claims data and processes the department’s invoices, prepares reports utilizing the department’s systems including but not limited to Origami, RL/Quantros and iContracts.  The individual carrying out this position will support the Wellforce System captive operations including the development of reports and presentations related to the Wellforce Indemnity Company, Ltd. Board and Underwriters Meetings.  In addition, the individual will support the development and on-going management of the Wellforce Enterprise Risk Management Program.  

The individual must understand and professionally represent the entire property and casualty insurance portfolio and prepare reports for Wellforce leadership, committees and various State Agencies (such as Mass. Board of Registration in Medicine and the Department of Industrial Accidents) to meet regulatory compliance.  The position will respond to all certificate of insurance requests and manage the databases involving COIs, vendor contracts, insurance policies and department invoices while reporting on variances involving budgets.  The position prepares claims correspondence, arranges departmental and external meetings and maintains all office and routine systems.

Under the general supervision of the Claims manager and regular interaction with the Wellforce System Insurance Director, the position handles highly sensitive, confidential risk management, property and casualty claim/suit information.  The position interacts with leadership, attorneys, courts, state agencies, adjusters, physicians and other professional staff. The position has overall responsibility for the timeliness of reports and assigned projects as well as the accuracy of the claims and other data used in reports and correspondence.   PRINCIPAL DUTIES AND ESSENTIAL FUNCTIONS:

• Drafts, types and forwards correspondence to outside attorneys, paralegals, insurance companies, governmental agencies, patients, physicians and employees.
• Organizes and prioritizes tasks effectively.
• Work involves frequent telephone and written contact with patients, attorneys, insurances companies, governmental agencies and hospital staff. Prepares litigation agenda for senior management.
• Enters and maintains information in databases for all property and casualty line and the enterprise risk management program
• Prepares loss runs, incident and trending reports, data validation reports for claims meetings as well as special reports, as required.
• Sets up claim files, prepares initial paperwork, input and transaction sheets in a timely fashion. Notifies insurers and reinsurers on claims, including providing updates.
• Coordinates communications between the claimant and the insurance company under the direction of the claims adjuster or Insurance Directors.
• Maintains office files and Department Directories.
• Prepares information and reports as required by state agencies, such as the Board of Registration in Medicine and the Department of Industrial Accidents.
• Schedules appointments and meetings, as needed.
• Maintains collaborative team relationships with peers and colleagues in order to effectively contribute to the Wellforce System’s achievement of goals, and to help foster a positive work environment.
• Performs other similar job related duties as required or directed.

Qualifications

JOB KNOWLEDGE AND SKILLS:

• At least 3 years of insurance industry experience, preferably in an underwriting assistant or claims processor role.
• Excellent math, communication and writing skills required. 
• Excellent project management skills.
• High degree of proficiency in Microsoft Product Suite, especially excel and PowerPoint.
• Excellent analytical skills
• Familiarity with healthcare/ industry is preferred. 
• Ability to communicate effectively with hospital staff, patients, outside attorneys, insurance companies and governmental agencies.
• Must be able to maintain accuracy while working under pressure and tight deadlines.
• Performs independently within department policies and practices. 
• Refers specific complex problems to leadership where clarification of departmental policies and procedures may be required.

EDUCATION:

• Bachelor’s degree preferred.

EXPERIENCE:

• Three years of related experience.
• Data entry skills and PC experience required.
• An equivalent combination of education and experience, which provides proficiency in the areas of responsibility listed above, may be substituted for the above education and experience requirements.

WORKING CONDITIONS/PHYSICAL DEMANDS:

• Normal office work environment.

Additional Information

All your information will be kept confidential according to EEO guidelines.

AMERICANS WITH DISABILITIES STATEMENT:

Must be able to perform all essential functions of this position with reasonable accommodation if disabled.

The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed, as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Tufts Medical Center reserves the right to modify position duties at any time, to reflect process improvements and business necessity.

All your information will be kept confidential according to EEO guidelines.