Claims Processor

5 days ago

Fort Wayne, United States Brotherhood Mutual Full time

Job Title: Claims Processor - Work Comp

FLSA Status: Non-Exempt

Job Family: Claims - Work Comp

Department: Claims - Work Comp

Location: Corporate Office (Fort Wayne, IN)

JOB SUMMARY

Responsible for effectively analyzing, verifying, authorizing, and resolving claim tasks and diaries and assisting the workers’ compensation adjusters and medical specialists with initial contacts and follow-ups on claims consistent with claims department standards and company objectives.

POSITION ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Analyze and process scheduled indemnity benefit payments. Assist all workers’ compensation adjusters with initial calls on minor claims to document course and scope of employment and compensability. Apply workers’ compensation statutes, common law, filing requirements, and other applicable legal and regulatory concepts related to assigned tasks. Review and document findings/summary from Index reports, vendor invoices and reports, code for payment, process payment, and determine if review is needed by assigned adjuster. Review medical bills and records, document summary, code for payment, and route to bill review. Request needed/missing medical bills or records, via phone or written request. Review, code, and process or route TPA drafts or approval of payments. Ensures timely and accurate processing of indemnity benefit payments. Assist with state regulatory filing requirements via EDI, state web-based systems, or paper. Ensure timely and accurate processing of regulatory compliance filings within mandated time frame to avoid fines and penalties. Further the attainment of overall claims department objectives by assisting all adjusters as needed. Maintain a caseload of minor medical claims at peak volume times. Resolve assigned claims and tasks in accordance with claim adjustment procedures and service standards. Achieve established claim file audit objectives. Ensure the security and accuracy of checks directly issued through the claims processing system. Complete other projects as assigned.

KNOWLEDGE, SKILLS, AND ABILITIES

The requirements listed below are representative of the knowledge, skills, and/or abilities required to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Must be able to effectively communicate with others (both oral and written). Must be able to make independent decisions. Must have strong interpersonal and organizational skills. Must have the ability to handle confrontational situations in a productive manner. Experience in investigation, customer service, and/or negotiation would be beneficial. Possess some insurance, legal and/or medical knowledge. Should be able to sit for prolonged periods of time. Effectively interface with external contacts, Brotherhood employees, managers, and department staff members.

EDUCATION AND/OR EXPERIENCE

Must have a high school diploma or equivalent. Must fulfill required adjuster licensing requirements. Bachelor’s degree desired. Insurance-related course work is desired.

Terms and Conditions

This description is intended to describe the general content of and requirements for the performance of this position. It is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.

Because the company’s niche is the church and related ministries market, and because effective service requires a thorough understanding of this market, persons in this position must be familiar with church operations and must conduct themselves in a manner that will neither alienate nor offend persons within this target niche.

Brotherhood Mutual Insurance Company reserves the right to modify, interpret, or apply this position description in any way the company desires. This job description in no way implies that these are the only duties, including essential duties, to be performed by the employee occupying this position. This position description is not an employment contract, implied or otherwise. The employment relationship remains “at-will”.

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