Claims Clerk Ii Job Description Sample
Claims Clerk II Property And Casualty
Amtrust Financial Services, a fast growing commercial insurance company, has an immediate need for a Casualty Claims Clerk II in the Irvine, CA office. The claims clerk performs various support functions for the claims department that include, but are not limited to, those listed in the essential job functions section below.
Experience with claims setups and mail indexing in property and casualty claims.
Monitors the daily Team performance, trends and provides the necessary coaching to staff to ensure adherence to policies and procedures.
Assist in the hiring and the training process.
Assist in the writing and delivering of the annual performance evaluations.
Works closely with other departments to assist with questions and requests.
Assist with the day to day tasks and answer questions from Team members and other departments.
Keeping management updated of any issues that may arise.
3 to 5 years of experience in a claims department and/or claims operations preferred.
At least 1 to 2 years of management or Team Lead experience desired.
Strong knowledge of claims procedures and policies, desired
Strong organizational skills and ability to multi task, with minimal supervision and must be able to exercise independent sound business judgement based on experience and policies and procedures.
Excellent verbal and written communication skills, with the ability to communicate effectively with all levels of the organization.
Intermediate to expert level working in Excel, Outlook and Word programs.
Ability to learn new procedures quickly and adapt to a changing environment
Acts with a sense of urgency to advance priorities.
Ability to work in a team environment
Ability to maintain professionalism and respectfulness under pressure.
Ability to multi-task and work with multiple computer screens.
Type 45 wpm, while still adhering to quality controls.
Ability to work in a diverse work environment.
What We Offer
AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Vacation and Holidays.
Claims Adjuster II
2721 N Central Ave, Phoenix, Arizona 85004 United States of America
Under the general direction of the Claims Manager, Republic Western Insurance Company (RWIC), responsible for the investigation, evaluation and settlement (either by denial, compromise or payment) of claims arising from physical damages to vehicles, property of customers (higher and more complex cases) and third parties (medium to high exposure bodily injury claims). Direct tasks and activities of independent adjuster and other support services. Review and negotiate rates for services provided. Supervise work product of subordinate adjusters on complex claims. Perform a variety of duties which require in-depth knowledge, specialized training and experience to understand risks under management, products offered and insurance investigation techniques within the claims office. Must maintain integrity of proprietary information
We are looking for a team player with a great attitude, desire to learn, and high level of enthusiasm.
3-4 years of experience in claims or a claims related field
College degree preferred
Strong analytical skills
Excellent phone communication skills
Basic computer skills with knowledge of Microsoft Word and Excel
Must be willing to become licensed within 12 months of employment in states that require it
Bodily Injury claims experience is a plus
Health insurance/benefits (including medical, dental & vision)
Subsidized gym membership (including paid fitness classes)
Business and travel insurance
MetLaw Legal program
MetLife auto and home insurance
Discounts on Apple products, cell phone plans, hotels and more
Commuter benefits program
Paid holidays, vacation and sick days
In-house cafe featuring options for all diets
24-hour physician available for kids
Community volunteer opportunities
Opportunity to travel for digital marketing conferences
Work Status: Full-Time
U-Haul is an equal opportunity employer. All applicants for employment will be considered without regard to race, color, religion, sex, national origin, physical or mental disability, veteran status, or any other basis protected by applicable federal, provincial, state or local law. Individual accommodations are available on requests for applicants taking part in all aspects of the selection process. Information obtained during this process will only be shared on a need to know basis.
Hfhp Claims Analyst II - HF Claims Administration, HF Administrative Plan Inc., Full-Time
The HFHP Claim Analyst II is responsible and accountable for providing Quality / No Harm, Customer Experience, and Stewardship by analyzing and resolving complex claim issues utilizing expert knowledge of benefit plans, provider contracts, employer/member contracts and Medicare
pricing methodologies. Success in this position will be based on the individuals' ability to effectively prioritize work, identify and resolve complex concerns in a professional manner, and work in a team environment to achieve common goals.
Ensure that communication and resolution of claim issues occurs in a timely manner to allow claims processing to meet all State and Federal prompt pay standards.
Demonstrating advanced knowledge of Health First Health Plans medical benefits, provider reimbursements, Medicare program administration and benefits, and Employer Group Health Plan requirements.
Demonstrating proficiency with core applications, including Health First Health Plans' administrative system, pharmacy system software, and web portals
Responds to provider appeals as it relates to disputed claims payment.
Analyze claim disputes received through call tracking issues and respond within 30 days.
Provide subject matter expertise in testing of new benefits, contracts, pricing mechanisms or systems.
Maintain relevant departmental policies and procedures.
Active self-directed learning at least 4 training events per year. These events can include: CMS Webinars; CMS on-line learning, In-depth study of departmental research materials with follow up presentation to the team.
Acts as a training resource for internal/external customers to understand and identify coordination of benefit applications and/or pre-existing requirements.
Advanced analysis of episodes of care, demonstrating acuity for isolating problems and providing training for correction of identified issues.
Analyze any claims processing questions to provide knowledge and expertise in accurate claims payment.
Identify any billing/reimbursement trends to assist in accurate reimbursement by the Health Plan.
Initiate and follow up provider refund requests within compliance guidelines
Maintain and track overpayment requests in Microsoft Access.
Coordinate the accurate application of any overpayment receipts.
Interact with coding and clinical services to analyze coding irregularities.
High School education or equivalent; some college preferred.
Minimum of 7 years claims processing experience or related health care billing and 2 years COB experience.
Advanced knowledge of medical benefits, medical and dental terminology
Advanced knowledge of claim adjudication and benefit plan application for indemnity plans, HMO plans, POS plans or Medicare.
Successful completion of an advanced Knowledge Survey to demonstrate proficiency.
Advanced knowledge of health care financing and health care delivery.
Advanced knowledge of Medicare eligibility, coverage and payment provisions.
Advanced knowledge of commercial insurance provisions.
Advanced Microsoft Office skills including:
Microsoft Word- professional letter writing skills, mail merge and document management
Excel - pivot tables, filtering, complex functions as well as creating charts and graphs
Access - queries, importing/linking data and letter generation.
Excellent Customer Service skills with ability to explain complicated benefit issues to members and diffuse hostile encounters.
Excellent oral and written communication skills.
Workers Compensation Claims Clerk
AmTrust Financial Services, a fast growing commercial insurance company, has an immediate need for a Workers Compensation Claims Clerk in the Maitland, Florida office. The successful candidate will perform various support functions for the claims department. This is a great entry level position for a person who is looking for a career path with a growing company.
Provide telephone support for incoming calls, including taking loss notices that are called in
Open, sort, scan and complete initial indexing information on incoming mail
Create, organize, and ship out claim kits to new accounts
Operate a variety of office equipment, including computers, printers, copy machines, facsimile receiver/transmitter and mailing equipment
6 months experience in an insurance claims department or related experience
Self organized and detail oriented
College degree preferred
Ability to work well under pressure, multi-task in a fast-paced environment, and meet production guidelines
Basic understanding of business technology
Claims Adjuster II
Marriott International is the world's largest hotel company, with more brands, more hotels and more opportunities for associates to grow and succeed. We believe a great career is a journey of discovery and exploration. So, we ask, where will your journey take you?
A Claims Adjuster II is responsible for the timely, good faith adjustment and disposition of self-administered casualty claims in multiple jurisdictions. Responsibility extends to all aspects and phases of investigations, evaluations, negotiations and settlements/denials of the following claims: workers' compensation, auto liability, no-fault uninsured motorist and general liability.
SCOPE/BUSINESS CONTEXT/EXPECTED CONTRIBUTIONS
Manage 100-150 casualty claims on assignment.
Acceptable caseloads vary based on the jurisdiction(s), mix and complexity of Worker's Compensation and General Liability cases as determined by Claims Unit Manager.
Investigate claims promptly – taking statements as necessary – to determine liability/compensability.
Evaluate damages and pay benefits as prescribed by law and/or Marriott policies and procedures.
Secure necessary documentation to facilitate timely loss adjustment and maintain primary responsibility for settlement decisions up to individual authority.
Complete and monitor timely WC payments/state filings.
Monitor and actively manage WC medical treatment with the goal of minimizing disability. Consult Occupational Health Services as necessary.
Manage litigation cases including controlling/directing outside attorneys, assisting in discovery/trial preparation and strategy.
Evaluate claims for potential third party or subrogation recovery.
Participate in the Service Call Program and complete required Service Call reports detailing current case status.
Actively participate in regularly scheduled unit meetings and department meetings.
Comply with Marriott Casualty Claims Policy and Procedure Manual requirements.
Effectively utilize the Valley Oaks System (iVOS) to manage all claims electronically.
Enter action plan notes/website notes into iVOS.
Participate in activities that foster teamwork and continuous quality improvement.
- Minimum of 18 months claims adjusting experience.
Knowledge and Skills
Ability to grasp and apply technical knowledge, including litigation case management and adjusting skills.
Effective reasoning, analysis and decision making skills.
Effective influence skills.
Strong negotiation skills.
Strong organization skills.
Strong hospitality skills.
Demonstrate strong leadership abilities.
Ability to prioritize work.
Ability to meet deadlines and follow up in a timely manner.
Good communication skills (verbal, listening, writing), including the ability to deliver difficult messages to customers and/or claimants.
Good investigation skills.
Basic knowledge of claims process.
Strong computer skills.
Ability to work well in a team, providing assistance to fellow associates and representing the mission of the unit.
Possess a willingness to accept and respond positively to constructive criticism.
Present oneself with a positive, professional demeanor.
Communicate often with supervisor keeping him/her informed.
Education or Certification
High School Diploma or GED preferred.
Two or four year degree from an accredited college/business/technical school preferred.
Applicable industry licensing.
Associate in Claims or Associate in Risk Management preferred.
Marriott International is an equal opportunity employer committed to hiring a diverse workforce and sustaining an inclusive culture. Marriott International does not discriminate on the basis of disability, veteran status or any other basis protected under federal, state or local laws.
Property Field Claims Spec II (National Catastrophe Field Claims Adjuster)
If you're passionate about becoming a Nationwide associate and believe you have the potential to be something great, let's talk.
Number 54 on the Fortune Magazine 100 Best Places to Work.
JOB SUMMARY: Investigates and resolves personal lines property damage claims via phone and face-to-face claims handling of a moderate to severe nature.
Promotes and provides "On Your Side" customer service. Responsible for the handling of claims in accordance within prescribed authority and adhering to best claims practices.
RELATIONSHIP: Reports to Claims Manager
DIRECT REPORTS: None
Promptly and effectively handles to conclusion all assigned claims with little to no direction and oversight. Makes decisions within delegated authority as outlined in company policies and procedures. Adheres to high standards of professional conduct consistent with the delivery of superior service.
Determines proper policy coverages and applies best claims practices to conclude assigned cases in accordance with company guidelines. Adheres to high standards of professional conduct while providing delivery of superior claims service.
Opens, closes and adjusts reserves in accordance with company practices designed to ensure reserve adequacy. Recommends Special Reserves where necessary.
In accordance with Corporate Reserving Guidelines. Adheres to file conferencing notification and authority procedures.
Maintains current knowledge of insurance and applicable product/services; court decisions which may impact the claims function; current guidelines in the claims function; and policy changes and modifications. This may require attendance at various seminars and/or training sessions.
Maintains current knowledge of local industry repair procedures and local market pricing.
Submits severe incident reports, reinsurance reports and other information to claims management as needed.
Partners with SIU and Subrogation to identify fraud and subrogation opportunities. Assists or prepares files for suit, trial, or subrogation. (Property/MD/Casualty).
Initiates and conducts follow-ups via proficient use of the claims systems and other related business systems.
Delivers a positive On-Your-Side customer service experience to all internal, external, current and prospective Nationwide customers.
Adheres to high standards of professional conduct while providing delivery of superior claims service.
Other duties as assigned.
Education: Undergraduate degree or equivalent experience.
Licenses/Designations: State licensing where required. Successful completion of required/applicable claims certification training/classes.
Experience: Three to five years related property claims experience. Experience in a customer service environment including flexible work schedules and extended work hours preferred.
General knowledge of insurance theory and practices, and contracts and their application.
Property estimating and automated claims systems. Proven knowledge of the investigation, negotiation and settlement activities used to resolve extensive property damage claims.
Skills/Competencies: Proven ability to meet customer needs and provide exemplary service by informing customers of the claims process and ensuring a positive customer experience.
Analytical and problem solving skills necessary to make decisions and resolve conflict in such areas as application of coverages to submitted claims, application of laws of jurisdiction to investigation facts, application of policy exclusions and exceptions. Ability to establish repair requirements and cost estimates for property losses. Ability to evaluate and successfully negotiate property claims.
Organizational skills to effectively prioritize work. Command of written and verbal communication skills for contact and/or negotiation with policyholders, claimants, repairpersons, attorneys, agents and the general public. Ability to efficiently operate a personal computer and related claims and business software. Provided leadership to to less experienced claims associates
Values: Regularly and consistently demonstrates the Nationwide Values and Guiding Behaviors.
Staffing Exceptions to the above Minimum Job Requirements must be approved by: Business Unit Executive and Human Resources.
Working Conditions: Normal office or field claims environment.
May require ability to sit and operate telephone and personal computer for extended periods of time. Representatives may be required to operate an automobile and have a valid driver's license with a safe driving record. Must be able to make physical inspections of property loss sites.
Must be able to climb ladders, balance at various heights, stoop, bend and/or crawl to inspect vehicles and structures. Must be able to work out-of- doors in all types of weather. Must be willing to work irregular hours and to travel with possible overnight requirements.
May be on-call. Must be available to work catastrophes (CAT). Extended and/or non-standard hours as required.
Credit/Background Check: Due to the fiduciary accountabilities within this job, a valid credit check and/or background check will be required as part of the selection process.
ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.
Job Evaluation Activity: Edited 5/2/11 JTG
Additional Job Description
This position is with Nation Catastrophe Team.
Ideal candidate will possess insurance claims experience or construction related experience.
The position can be filledat a lower level depends on experience.
Job ID: 51415
Claims Rep II Or III | (Medicare Claims Processing Required) | Cerritos, CA
Your Talent. Our Vision. At CareMore, a proud member of the Anthem, Inc. family of companies specializing in providing senior Americans a complete and pro-active health care experience, it's a powerful combination. It's the foundation upon which we're creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve.
Responsible for keying, processing and/or adjusting health claims in accordance with claims policies and procedures. Primary duties may include, but are not limited to:
Participate in claims workflow projects.
Responds to telephone and written inquiries and initiates steps to assist callers regarding issues relating to the content or interpretation of benefits, policies and procedures, provider contracts, and adjudication of claims.
Adjusts voids and reopens claims on-line within guidelines to ensure proper adjudication.
May have customer/client contact.
May assist with training of staff.
Works without significant guidance.
Requires a HS diploma
3-5 years experience processing Medicare and/or Medicaid claims
1+ year experience in claims adjudication
Claims Clerk (11599)
The claims clerk job is to receive and prep mail for the incontestable and contestable life claims units. Claims clerks are to make sure that the proper paper work is included in the received mail since different pieces of mail are needed to process a claim depending if it is incontestable or contestable. If the proper paper work is missing the claims clerk will request a systematic letter to request the needed information. The claims clerk also prepares follow up letters to the beneficiary. If no additional information is needed, the mail is sent to its respective department. The claims clerk also updates information in the system with regards to claim status. Claims clerks perform a variety of other functions which can include; match medical records to files, match contestable claim correspondence to files, working pending proof reports, follow up on all claim in suspense, follow up on reconciling items received from accounting, and follow up of claims where a minor beneficiary is involved.
Opens and sorts mail to be given to the incontestable or contestable life claims units.
Requests additional missing information to process claims.
Updates the system with current status of claims.
Matches medical records to files.
Matches contestable claim correspondence to files.
Researches all claims in suspense status.
Researches reconciling items received from Accounting.
Researches claims involving a minor beneficiary.
Works pending proof reports.
Maintains production records of work performed and must meet the minimum production quotas set by the department.
Other duties; as requested by the supervisor.
Must be pc/Windows literate and posses a working knowledge of MS Office (Outlook, Excel and Word).
Data entry and 10-key skills by touch and sight.
High School Diploma or GED equivalent.
Job LocationOklahoma City, Oklahoma, United StatesPosition TypeFull-Time/Regular
Warranty Claims Clerk
MPP Company, as a leader in the industry, provides a comprehensive selection of extended warranty services and other automotive protection plans designed to give our customers the best buying and ownership experience. We provide vehicle service contracts (frequesntly referred to as extended warranties), maintenance contracts, paintless dent repair, lease wear coverage and more.
Receive documents in from dealers and customers
Check email folders on a regular basis for incoming documents to import into scanning software
Index documents to the correct department for processing
Contact customers / dealerships concerning payable issues
Other duties may be assigned
Strong keyboard skills including 10 key
Minimum high school diploma or GED equivalent required
Excellent customer service skills, underwriting background a plus
Ability to be analytical and multi-task
Ability to work with little supervision
Self-motivated, enthusiastic presence in a team environment
Strong written and communication skills
Working knowledge of Microsoft Office
Consistent and stable work history
Valid driver's license and clean driving record
Professional appearance and work ethic
All potential employees must pass pre-employment testing to include a background check and drug screen.
Competitive earning and overtime potential
Fast paced work environment
Paid training and development
Career growth opportunities with management potential
Medical and dental coverage available 2 month period
8500 Shawnee Mission Parkway
Merriam, KS 66202
Compensation: $14 - 15/ HR
Claims Clerk - Phoenix, AZ
Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work. SM
The Claims Clerk is responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims.
Provide general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims.
Authorize the appropriate payment or refers claims to investigators for further review.
Conduct data entry and re - work; analyzes and identifies trends and provides reports as necessary.
Analyze and identify trends and provide reports as necessary
Consistently meet established productivity, schedule adherence, and quality standards
Recognize claims by determining claim type - HCFA, Hospital, UB, and / or RX
Identify more complicated claims and refer them to Senior Claim Processor or Supervisor
Calculate other insurance and re-pricing benefits
Work claims files to ensure the appropriate eligibility and provider records are matched to the claim
Updates and maintains claims tracking database
High school diploma / GED or higher
1 years of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties
Basic proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
2 years data entry experience
1 years experience working with medical claims
Prior experience working with IDX software
1 years working in production based environment
Type 60 words per minute
Basic understanding of healthcare claims including ICD-9 and CPT codes
- Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
Physical Requirements and Work Environment:
Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in healthcare here. We serve the healthcare needs of low income adults and children with debilitating illnesses such as Cardiovascular Disease, Diabetes, HIV/AIDS and High-risk Pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive Healthcare, Community, and Government partners to heal healthcare and create positive change for those who need it most. This is the place to do your life's best work.SM
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Keyword: data entry; Claims; Healthcare; Clerk; Phoenix
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