Under moderate supervision, this position is responsible for partnering with claim professionals to assist customers. Responsibilities within the team include building customer relationships, completing financial transactions, updating and managing important business information, and handling numerous other duties and projects. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration.
Bilingual/Spanish candidates encouraged to apply.
Primary Job Duties & Responsibilities
- Customer Engagement:
- Serves as a customer service representative for the claim department by promptly and professionally addressing external and internal customer questions and concerns, which may include:
- Triage and route callers to the appropriate department.
- Answers claim status and payment questions.
- Claim Operational Service and Partnerships:
- Partners with claim professionals in multiple departments to assist with the timely resolution of claims, which may include:
- Properly documents claim files, including notes and diaries.
- Corrects wage statements.
- Requests police reports and medical records.
- Reviews medical bills for proper billing and coding.
- Prints and prepares claim documents for legal and medical reviews.
- Reports claims to other insurance companies.
- Assigns new claims to the appropriate claim professional.
- Transitions closed files to and from off-site storage using records management systems.
- Receives, sorts, scans, and uploads incoming mail. Researches for the appropriate recipient.
- Processes out-going mail, including overnight packages as needed. Orders, receives and distributes supplies and/or equipment.
- Claim Payments and Expense Processing:
- Ensures the proper handling of financial transactions to include:
- Processes and issues claim payments including outside vendor invoices, attorney expenses, and medical processing fees.
- Processes and documents returned checks, voided checks and credits.
- Ensures timeliness and accuracy of all check processing.
- Data and Information Management:
- Maintains accurate records and information management, such as:
- Prepares, generates and reviews daily/monthly/quarterly and ad hoc reports using the most effective technology.
- Updates data discrepancies identified in reports and systems.
- Uses management information data to prepare line of business or financial reports.
- Prepares operational reports for claim professionals and managers.
- Accurately documents pending and completed work activities using appropriate systems.
- Financial Controls and Assessments:
- Assists with claim center financial standards, including:
- Performs underlying controls and effectively communicates findings.
- Assesses the reasonableness of data as well as identifying discrepancies, including reconciliations.
- Assesses the effectiveness of financial controls. Prepares data entries in accordance with established standards. Supports statutory reporting requirements.