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Managed Care Claim Assistant I
1 month ago
Overview:
AmTrust Financial Services, a fast-growing commercial insurance company, has an opportunity for a Claim Assistant I within our Managed Care organization where your talent and abilities contribute to our competitive edge.
Responsibilities:- Processes Utilization Review requests: performs data entry functions, reviews multiple criteria to determine eligibility of treatment requests, approves treatment requests based on authority level, refers treatment requests to a clinical resource or sends appropriate response letter.
- Coordinates with adjusters or nurses to validate claims or clinical information respectively to make decisions related to eligibility of treatment requests.
- Prioritizes treatment requests based on review type and ensures jurisdictional timeframes and/or department turnaround times are met.
- Appropriately documents all systems to reflect critical thinking and actions taken in response to treatment requests.
- Works collaboratively with the claims and managed care teams to manage the Utilization Review process or for other administrative tasks as needed
- Performs general maintenance of claims documents in various systems
- Other administrative tasks as assigned by clinical review nurses, nurse case managers, or supervisor
- General knowledge of workers' compensation claims procedures and policies
- Ability to take direction, think critically, and make decisions
- Self-organized and detail oriented
- Ability to learn new procedures quickly and adapt to a changing environment
- Professional telephone demeanor and good oral and written communication skills
- Ability to work well under pressure and multi-task in a fast-paced environment
- Basic understanding of business technology
- Ability to work in a team environment
Education:
- High school diploma
- Some college preferred
- 1- 3 years of experience in a worker's compensation claims department or related experience
This job description is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities, duties, or responsibilities that will be required in this position. AmTrust has the right to revise this job description at any time.
What We Offer:AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.
AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.
AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.
