Claims Operations Assistant

Provide support to the Claims Department by preparing reinsurance reports, printing checks daily and generating essential reports.  Ensures the accuracy and completeness of claims coding, entry of claims payments, claims financial activities and compliance with security both internally and regulatory and Sarbanes-Oxley 404 requirements.  Assist other departments to access necessary financial information and make changes to system data, with proper documentation, when necessary.

ESSENTIAL FUNCTIONS:

1.            Gather the latest and most pertinent data to generate reinsurance reports.  This includes, but is not limited to, the review of “Changes in Large Loss" and “New Claims Incurred" reports and other germane reports to target claims for proactive reinsurance reporting.

2.            Verify W-9s as necessary via the Internal Revenue Service website.  Obtain W-9s from payees when necessary.  Enter information into various systems as required.  Process year end 1099s.

3.            Provide the Support Assistants direction on the processing and implementation of new programs and activities.

4.            Perform all data entry of bonds and bond maintenance as required.

5.            Daily audit and approval of “Check Register" and/or drafts.  Confirm adequacy of balance of self-insureds.  Ensure drafts meet insurance company or self-insured program requirements.

6.            Perform all cancel/rewrites of claims assigned by Manager.  Assist with performing necessary changes to claims data entry.

7.            Preparation and verification of daily, weekly and monthly report data and analysis as requested

8.            Research and maintain documentation of positive pay suspect items after notification from Accounting.  Validates and maintains paper trail and copies to Controllers.

9.            Maintain documentation regarding drafts destroyed for misprints or data errors.

10.       Provide voided draft information by insurance company or self-insured program to Accounting monthly. 

11.       Provide assistance to all branches with claims entry or data processing as assigned.

12.       Assist with resolving any claims financial issues for Claims and Accounting or other financial departments within MIG.

13.       Maintain any financial documentation for claims payments as necessary.

1.      High school degree or equivalent required. 

2.      Understanding of basic claim functions.

3.      Knowledge of IRS reporting systems.

4.      Ability to build effective working relationships with associates and branch management.

5.      Effective communication skills both oral and written with good interpersonal skills.

6.      Strong attention to detail.

7.      Ability to work on multiple projects simultaneously.

8.      Proficiency in Word, Excel, Access, and Outlook.

9.      Excellent organizational and problem-solving skills.

10. Ability to foresee and identify potential problems.  Respond in a timely manner to those potential problems identified by others.

11. Knowledge of medical terminology and CPT, ICD-9 and HCPC coding.

12. Knowledge of standard medical billing forms.