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Claims Representative

Collabera Plano, TX Contractor
$14.00 - $15.00 / hour
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Determines customer eligibility by reviewing contractual language and medical documentation, interprets information and makes decisions based on facts presented

Works directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis

Networks with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information

Pays all covered claims accurately and timely

Executes on all customer performance guarantees

Responds to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner

Ability to handle potentially high levels of call volume from customers and clients

Exhibits claim management performance according to quality and compliance standards

Manages both new claims and open claims equally and maintains decision times

Adheres to standard timeframes for processing mail, tasks and outliers

Supports and promotes all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.)

Demonstrates focus on team and office goals by developing an understanding of relationships with our business partners and positively interacting with business partners as needed

Understands Group Operations and Corporate Compliance, Polices and Procedures and best practices

Stays abreast of ongoing trainings associated with role and business unit objectives


Exceptional customer service standards and delivery

Strong oral and written communication skills

Ability to prioritize and multi-task

Ability to thrive in a fast-paced environment and meet deadlines

Strong math and calculation skills

Excellent interpersonal, organizational, negotiation, investigative, analytical and research skills

Conflict resolution skills

Critical attention to detail

Team oriented

Proficient in MS Office

Multilingual skills are highly desired


High School Diploma Required

BA/BS degree or equivalent work experience Preferred

Minimum of 1 year disability claim management experience Preferred

Recommended skills

Attention To Detail
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