SUMMARY: The primary focus of this position is to provide support to the Claim
Team. This includes but is not limited to returning phone calls, creating notes
in system, closing claim files, and assisting in preparation of file reviews as
well as other miscellaneous support activities. Computes medical bills
associated with accidents and ensures timely payment.
RESPONSIBILITIES/TASKS:
Supports the customer service work and processes for the multi-functional
claims team.
Answers general claim inquiries from providers and provide verification of
claim status.
Communicates and collaborates with team members to ensure the appropriate and
timely handling of claims. Supports the team as required.
Supports the account management process appropriately for the team's book of
business.
Computes the proper payment for the medical bills for non-indemnity and
simple indemnity claims directly associated with the accident or activity.
Computation is based on knowledge of the treatment given the individual and
its relationship to the injury to relieve and/or cure the injury sustained as
well as workers’ compensation provisions in the state the employer is
domiciled.
Provides administrative support to the Claims Department using word
processing and spreadsheet applications. (Lien letters, timelines for medical
treatment/events, etc.)
Ensures that all payments are made in an accurate and timely manner and that
all files are closed to meet internal performance standards while complying
with state legislation to avoid penalties and reduce the amount of
supplemental bills.
Adheres to the Employee Code of Ethical Conduct.
Completes other duties and special projects as requested
This position description identifies the responsibilities and tasks typically
associated with the performance of the position. Other relevant essential
functions may be required.
EMPLOYMENT QUALIFICATIONS:
EDUCATION OR EQUIVALENT EXPERIENCE:
High school diploma or G.E.D required. College coursework in English,
Mathematics, Business Administration or Administrative Management OR the
equivalent in insurance-related course work and experience is required. At least
2 years of administrative experience. Continuous learning required, as defined
by the Company’s learning philosophy. Certification, or progress toward, highly
preferred and encouraged.
EXPERIENCE:
Previous experience in an insurance environment or previous knowledge of
workers' compensation laws is desired. Knowledge of medical terminology is
preferred.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
1. Ability to work independently as well as in a multifunctional business unit
is essential.
2. Effective oral and written communication skills are essential.
3. Excellent customer service and organizational skills are essential.
4. Ability to manage multiple priorities and adapt to changing workflow in
order to still meet deadlines and goals are essential.
5. Proficient in Microsoft Windows
6. Attention to detail and analytical skills required.
7. Ability to enter and verify alpha/numeric data accurately.
WORKING CONDITIONS:
Work is performed in an office setting with no unusual hazards.
PAY RANGE:
Actual compensation decision relies on the consideration of internal equity,
candidate’s skills and professional experience, geographic location, market, and
other potential factors. It is not standard practice for an offer to be at or
near the top of the range, and therefore a reasonable estimate for this role is
between $39,100 and $65,600.
The qualifications listed above are intended to represent the minimum education,
experience, skills, knowledge and ability levels associated with performing the
duties and responsibilities contained in this job description.
We are an Equal Opportunity Employer. Diversity is valued and we will not
tolerate discrimination or harassment in any form. Candidates for the position
stated above are hired on an "at will" basis. Nothing herein is intended to
create a contract.
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