Claims Service Representative II
1 month ago
This position handles first party medical payment claims including fatalities (PIP and Med Pay) for our Eastern Claims Division which currently covers ten different states.
Position responsibilities include but are not limited to:
- Ensuring compliance with insurance regulations, company policies, and industry standards in all aspects of claims handling.
- Investigating, evaluating, and resolving coverage questions in compliance with applicable state laws/regulations and policy provisions.
- Evaluating and processing medical bills/invoices related to auto insurance claims promptly and accurately. This includes thorough reviews of medical bills, ensuring that the charges are reasonable, necessary, and compliant with applicable regulations and policy provisions.
- Preparing correspondence, obtaining medical and employment related records, and calculating wage loss claims per applicable state laws.
- Maintaining detailed and organized claim files and documenting all relevant information, correspondence, and decisions made throughout the bill review process.
- Communicating and interacting effectively verbally and in writing with medical providers, policyholders, claimants, attorneys, and other involved parties to gather information, explain benefits, coverages, claims processes, and provide updates on claim status in compliance with regulatory and statutory requirements.
- Retaining and monitoring vendors in a cost-effective manner.
- Identifying and initiating subrogation reviews as appropriate.
- Identifying opportunities for process improvement and contributing to the development of best practices within the claims department.
Education:
- 4-yr. College Degree or equivalent combination of education and work experience required.
Experience:
- Ability to service claims of low to moderate complexity, as normally acquired through 3-5 years’ experience.
Knowledge/Skills/Competencies:
- Moderate computer and line of business technical software skills required.
- General knowledge of coverage, causation and subrogation principles desired.
- Moderate understanding of medical terminology desired.
- Advanced organization and planning recognition skills required.
- Advanced oral and written communication skills required.
- Advanced interpersonal skills required.
Special:
- Valid driver's license with a level of financial responsibility required by the club and an acceptable motor vehicle record required for field positions.
Remote work is based on manager discretion and performance. Onboarding and training will be conducted on-site at an Auto Club facility. Employees must demonstrate reliability and proficiency in the department to be considered. Employees must have adequate high-speed internet, minimum of 50 Mbps. Employees must live within a reasonable commuting distance of their assigned Claims Unit. Employees assigned to a Claims Unit are required to report to the office for coaching and training opportunities upon request.
Remarkable benefits:
• Health coverage for medical, dental, vision
• 401(K) saving plan with company match AND Pension
• Tuition assistance
• PTO for community volunteer programs
• Wellness program
• Employee discounts (membership, insurance, travel, entertainment, services and more)
"Through dedicated employees we proudly deliver legendary service and beneficial products that provide members peace of mind and value.”
AAA is an Equal Opportunity Employer
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