Claims Associate - Consumer
Remote
3 Months - Contract
Notes:
Looking for Property & Casualty license
Must be bilingual English and Portuguese or Spanish
Job Description
PRIMARY PURPOSE: To provide high-quality service to both internal and external customers, delivering an easy and efficient customer experience for routine lost time.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Processes incoming calls, faxes and voicemails from claimants, providers, clients, attorneys, etc., resolving their claims related questions and issues in accordance with designed guidelines and policies.
Communicates claims status and current claim activity with client and appropriate medical contact; responds to inquiries about jurisdiction- and claim-specific issues.
Enters data into claims system(s) and ensures claim files are properly documented, and claims coding is correct.
Coordinates claimant address updates or changes with internal departments. Provides referrals to legal, utilization review, pharmacy, and Special Investigations Unit (SIU) as appropriate and coordinates independent medical examinations.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Education & Licensing
High school diploma or GED required.
Associate's degree from an accredited college or university preferred.
Professional certification as applicable to line of business preferred.
Experience
Two (2) years of administrative and/or customer service experience or equivalent combination of education and experience required.
Skills & Knowledge
Excellent oral and written communication skills
PC literate, including Microsoft Office products
Strong investigation and organizational skills
Good interpersonal skills
Ability to work in a team environment
Ability to meet or exceed Performance Competencies