· Job Description:
Processes less complex or small standard claims to ensure accurate and timely completion.
Essential Job Functions
· Enters insurance claims received electronically or in written form.
· Answers incoming customer calls regarding claim processing. Documents claim and associated history.
· Evaluates available information to validate straightforward basic claims. Verifies policyholder information, policy effective dates, premium status and verification of claim eligibility.
· Sends claim form to claimant for updating, correction or completion.
· Identifies need for additional information; contacts appropriate source to obtain needed information. Verifies beneficiary or claimant information if claim is warranted. Identifies payment amount and obtains required management approvals for payment. Processes payment.
· Advises claimant of status and resolution of claim. Escalates claimant concerns as appropriate.
· High school diploma or G.E.D.
· Zero or more years of claims experience
· Experience working with insurance and/or medical terminology
· Experience working with appropriate claims processing procedures and documentation
· Basic analytical and problem solving skills
· Interpersonal skills to interact with team members
· Communication skills to communicate with customers
· Data entry skills
· Ability to keep sensitive and confidential material private
· Ability to work in a team environment
· Office environment