Claims Associate Job Description
Claims Associate Duties & Responsibilities
To write an effective claims associate job description, begin by listing detailed duties, responsibilities and expectations. We have included claims associate job description templates that you can modify and use.
Sample responsibilities for this position include:
Claims Associate Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Claims Associate
List any licenses or certifications required by the position: ASE, ARM, CPCU, PGI, BCP, ASA, HCPCS, CPT, ICD
Education for Claims Associate
Typically a job would require a certain level of education.
Employers hiring for the claims associate job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Collage Degree in Education, Business, Associates, Accounting, Business/Administration, Finance, Computer, Engineering, Law, Public Health
Skills for Claims Associate
Desired skills for claims associate include:
Desired experience for claims associate includes:
Claims Associate Examples
Claims Associate Job Description
- The timely and accurate management of this position is essential for the reduction of firm risk and client exposure
- Uses telephone and web-based tools to access insurance benefit plans and claim/EOB information
- Contacts designated insurance payers to inquire on statues of appeals
- Communicates with insurance payers to obtain account information, such as benefits and payment details
- Escalates unresolved claims through the appropriate payer contact
- When needed, resubmits demand letters to insurance companies and ensures receipt by insurance
- Connects with department colleagues to resolve claim questions
- Acts cooperatively and maintains a professional attitude with co-workers, management and insurance companies
- Special projects as dictated by management.Adheres to all company policies and procedures including, but not limited to those identified within the Standards of Business Conduct and the Employee Handbook, as may be amended from time to time
- Work within a team to collect member records
- Conduct reviews of these records by contacting providers
- Place the results collected into a specific data base
- Work as part of a team to collect and review member records by contacting providers
- Enter results into the database
- Conduct on-site review in the provider office or hospital
- Organize and prepare records, data entry, database management, and email communication
Claims Associate Job Description
- Participate in user acceptance testing (UAT) activities to ensure business and system requirements are met
- Responsible for assigned inventory of files with recovery
- Processes invoices for various vendors involved in recovery, including attorneys, special investigators, medical experts
- Processes checks received from adverse parties/payees for payment
- Responsible for filing, faxing, photocopy, scanning and other general office functions
- Processes assigned claims and determines benefits due pursuant to the client contract
- Process subrogation files
- Handles claim files (locates/requests files, files paperwork, moves misfiled documents, sends to other offices)
- Investigates claims by determining applicable policy coverage, evaluating damages, and settling assigned claims
- Communicates with clients via telephone to set up new claims and obtain necessary information
- Is able to manage own workload and determine urgency in a meaningful and practical way in order to meet business requirements and timescales
- Flexible, with a friendly, positive and willing attitude to working and learning
- Changes focus quickly as business needs change
- Previous experience of training, supporting, mentoring others
- Minimum requirement is GCSE in English and Maths
- Good computer and keyboard skills
Claims Associate Job Description
- Authorising payment within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements
- Responsible for reviewing a specific account, policy or relationship, remediating the exposure and then moving on to review the next account without taking on traditional account ownership and relationship servicing that is associated with it
- Review of wide range of information to properly identify correct ownership of counterparty including but not limited to Aon internal records, Atlas, Companies House, Aon Network information, Post Office records, International Directory Enquiries
- Identify differing approaches required for the differing account types including but not limited to Lloyds syndicates, Company Stamps, Liquidated Entities, Third Party Claims, Third Party Commissions, Intercompany Offices, Internal Suspense and Hold Accounts and Third Party Providers
- Be able to communicate effectively with contacts
- Be able to resolve queries or achieve results without having to fully resolve them
- Creation of payments in line with existing Payment Control Framework
- Completion of MI control reports
- Escalation of issues with XBS or to AON where applicable
- Achieve compliant results very quickly in order to meet targets set
- Conducts themselves by example adapting positively to support change initiatives
- Completion of background check and drug screening prior to assignment start date
- 1+ claim management experience is a plus
- Claims adjudication experience or paralegal experience
- Medical knowledge, fluency with assessment terminology
- Ability to identify priority in work assignment and make multiple decisions per day
Claims Associate Job Description
- Assist the Claims Account Executive to monitor & update claim status & create various claims reports
- This position will have the responsibility for the review and providing guidance of high exposure claim files to ensure reserves are properly set and maintained, demands are handled appropriately, the litigation process is maintained and regulatory standards are adhered to for compliance
- The position will also provide guidance to management for the handling, strategy and resolution of claims, including providing authority for settlement
- This position requires that you will become a subject matter expert in a variety of disciplines
- This position will also assist in providing guidance to all ACE markets for the handling, strategy and conclusion of complex claims files
- This position will require that you demonstrate discretion when assessing complex and unique claims
- The position will require that you work directly with Claims management to communicate trends and patterns on high severity and complex claims
- This position ensures claims representatives and personnel are effectively delivering legendary service through annual audits
- Demonstrates and model’s the Club’s mission and values for claims representatives and personnel
- Establish fair market value of vehicles assisting insurers in claim settlement
- Experience with initial eligibility review of long term care claims
- Experienced in using Windows applications
- Knowledge of requirements management and/or prototyping (ALM, Jira, RallyDev, Balsamiq, iRise)
- Knowledge of and Experience in the business processes and systems that handle Product and Benefits Administration, Claims, Benefit Determination, Accums, and/or Claims Recovery & Appeals capabilities
- SDLC Methodologies (XP, Scrum, OWF)
- Requirements Management Tools
Claims Associate Job Description
- Provide supplemental research as requested
- Submit ISO “initial” on all new FNOL
- New mail & faxes - tasks
- Check disbursement
- Approve/Review EDI payables
- Under moderate supervision, works within specific limits and authority to actively manage a caseload of lost time cases of moderate technical complexity in the Nevada jurisdiction
- Actively manage cases involving medical, legal and vocational rehabilitation issues
- Knowledge of the claim assignments and claims processing
- Review and interpret policy coverages
- Conduct a thorough investigation which will include telephone interviews from the insured, witnesses and others possessing facts concerning the claim
- There may be extended periods of confinement to work station during peak periods
- High school diploma or AA
- 1+ years customer service experience as a high-performing customer service/support representative
- College or University degree or alternatively Associate in Claims qualification
- Excellent knowledge of coverage forms and god analytical skills in policy interpretation
- Achieved ACII or equivalent relevant qualification, or legal framework background