Entry Level Claim Associate I

Entry Level Claim Associate I

Requirements

• Excellent oral and written communication skills.
• Individual must be a self-starter with strong organizational abilities.
• Ability to coordinate and prioritize required.
• Ability to operate general office equipment and perform clerical duties.
• Flexibility, initiative, and the ability to work with a minimum of direct supervision a must.
• Discretion and confidentiality required.
• Ability to work as a team member in a rapidly changing environment.
• Reliable, predictable attendance within client service hours for the performance of this position.
• Responsive to internal and external client needs.
• Ability to clearly communicate verbally and/or in writing both internally and externally.
• Associate’s degree or two year’s related business experience.
• Proficient with Microsoft Office programs.
• Must pass Texas Adjuster license as requested.

Responsibilities

• Set up designated claim files and complete all set up instructions, as requested.
• Learn multi line coverages, check claim for correct coverage type, assign out files to adjusters when supervisor is out, if applicable.
• Set up independent medical exams as deemed necessary under direct supervision.
• Request and monitor medical treatment of designated claims in accordance with corporate claim standards.
• Review and approve related medical, legal, damage estimates and miscellaneous invoices on designated claims.
• Assist adjuster with recorded statements.
• Negotiate any disputed bills/invoices for resolution under direct supervision.
• As appropriate, make referrals to outside vendors on designated cases under direct supervision. (i.e. legal, surveillance, case management, etc.)
• Effective and timely coordination of communication with clients, claimants and other appropriate parties throughout the claim adjustment process.
• Authorize and make payments on claims utilizing a claim payment program in accordance with industry standards and within established authority levels under direct supervision.
• Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim.
• Compute disability rates in accordance with state laws under direct supervision, when appropriate.
• Handle management of Navex and member/client complaints, if applicable.
• Assist in running and updating reports as needed.
• Return provider calls.
• Review and maintain personal diary on claim system.
• Provide technical and clerical claims support to designated clients and claim staff, as requested.
• Working document and bill queues.
• Process voids, refunds and recoveries.
• Act as backup for adjuster or supervisor when out of the office.
• Client Satisfaction.
• Compliance with corporate claim standards and special client handling instructions as established.
• Handle claim overflow as needed.
• Performs other duties as assigned.

Preferred Qualifications

• Knowledge of medical terminology preferred.