p>KNOWLEDGE & SKILLS: • Excellent customer service skills • Excellent written and verbal communication skills • Fast learner; develops knowledge and understanding of claims practice, relevant statutes, and medical terminology • Ability to identify, analyze and solve problems • Computer proficiency and technical aptitude to utilize Microsoft Office, including Excel spreadsheets • Strong interpersonal, time management, and organizational skills • Ability to work both independently and within a team environment.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
• Receives claims, confirms policy coverage and acknowledgement of the claim • Determines the validity and compensability of the claim • Establishes reserves and authorizes payments within established reserving authority limits • Communicates claim status with the customer, claimant and client • Adheres to client and carrier guidelines and participates in claims review as needed • Assists other claims professionals with more complex or problematic claims as necessary • Additional duties as assigned.