Claims Assistant

5 days ago

Stuart, United States Health in Tech Full time
SUMMARY

The Claims Assistant shall be responsible for a variety of support functions for Claims Operations, which includes, but is not limited to, handling the intake of Aggregate Accommodation Requests/Claim Submissions, updating the claim systems related to the receipt of high-dollar claim notifications and monthly reports received from Third Party Administrators ("TPAs") and/or Policyholders, preparing Aggregate Claim files for the Claims Staff, assisting with the Aggregate Claim Reconciliation Process when Stop Loss Policies are completed by pursuing the needed documentation from the TPAs/Policyholders, and performing other assorted tasks/responsibilities, as assigned.

ESSENTIAL DUTIES AND RESPONSIBILITIES
  • Perform Claim Intake Process, which includes, but is not limited to:
    • Creating a new claim folder in our shared file system.
    • Uploading the claim documentation into the new claim folder.
    • Setting up a new claim record in the claims system.
    • Cross reference any duplicate filings and coordinate with the Claim Specialists in relation to closing the previous filing.
  • Retrieve all Monthly Aggregate Reports from the TPAs and input them into the system.
  • Add all High-Dollar Trigger Notifications into the applicable shared file and claims system, and then consult with Claims Management to determine if further action is needed.
  • Add Plan Documents ("PDs"), Summary Plan Descriptions ("SPDs"), and Stop Loss Policies into the corresponding claim folders, as well as send requests to Account Executives to pursue missing PDs/SPDs.
  • As needed, follow up with TPAs and Policyholders to check status of requests for information and documentation in pended claim scenarios.
  • Assist with the Aggregate Claim Reconciliation Process, by pursuing needed information/documentation.
  • Support Claims Team when directed by Claims Management (i.e., other duties, as assigned).
Qualifications for the Claims Assistant include:
  • Requires a high school diploma or equivalent. Bachelor's Degree is a plus.
  • Claims and/or data entry experience preferred.
  • Strong analytical abilities, excellent verbal and written communication skills, sound organizational capabilities, and effective customer service skills are a must.
  • Highly proficient in Microsoft Office applications, especially Outlook, Excel, and Word.
  • Must have the ability to work effectively on a team, as well as work well independently.
  • Must be able to work in a fast-paced environment and maintain acceptable productivity, while maintaining a high level of quality.

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