Claims Processing Associate

4 weeks ago

Lansing, Michigan, United States AF Group Full time
Job Summary:

This role is responsible for the maintenance of incoming workload, issue resolution, and first report of injury (FROI) issues. The successful candidate will determine jurisdiction for entry of first notice of injury (FNOI) from multiple sources and distribute to the proper destination.

Key Responsibilities:

  • Identify jurisdiction, date of injury, and special/additional handling items; research and re-index non-new claim submissions to route to appropriate handling.
  • Receive incoming general new claims calls for all entities; backup for ACD calls in the event of telephone system shutdown.
  • Make changes, corrections, and updates on newly created and/or existing claims or submissions as well as guide end-users on process techniques in various applications.
  • May serve as a resource regarding intake-related issues, i.e., determine jurisdiction, assist in clearing policy issues to process claim; in finding coverage or other information.
  • May participate in training employees new to the role.
  • Process Workers' Compensation claims retrieved from Open Pool queues or via telephone; code body part, diagnosis, and cause of injury by entering submitted data in the claims system review claim for accuracy prior to completion and perform all tasks specified for state-specific requirements after claim setup.
  • Confirm policy coverage for date of injury, business location, and injury location; request policy update for locations as needed.
  • Maintain department procedures, working instructions, and job aides; may participate in creating new workflows or workflow changes.
  • Research multiple state and internal systems and document and route/or index incoming mail to appropriate region and/or department from unidentified mail queue.
  • Forward unidentified mail to sender using appropriate form letters.
  • Route documents to medical bill review vendor.

Requirements:

  • High school diploma or equivalent required.
  • Minimum of two years of general office experience, including customer service experience that provides the required skills, knowledge, and abilities.
  • Excellent verbal and written communication skills.
  • Ability to be an independent thinker to solve issues.
  • Excellent organizational skills and ability to prioritize work to meet established deadlines.
  • Basic knowledge of computers and spreadsheet software with data entry ability.
  • Basic knowledge of word processing software.
  • Excellent customer service skills.
  • Knowledge of multi-functional telephone system.
  • Ability to proofread correspondence for accuracy of spelling, grammar, punctuation, and format.
  • Ability to verify data for accuracy.
  • Ability to multi-task, i.e., interact on telephone while entering data.
  • Ability to work effectively with various business units.
  • Ability to train and coach others to perform the core responsibilities.
  • Ability to work varied hours/days/shifts.

Preferred Qualifications:

  • Insurance Institute of America (IIA) or other insurance-related coursework.
  • Knowledge of Workers Compensation or insurance.
  • Basic knowledge of spreadsheet software.
  • Knowledge of medical terminology.
  • Knowledge of claims reporting process for multiple states.
  • Experience using a document management system with workflows.
  • Other insurance-related coursework.
  • Experience providing customer service over the phone.
  • Excellent telephone etiquette.

Working Conditions:
Work is performed in an office setting with no unusual hazards. Work may be performed at varied hours/days/shifts.

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