Claims Associate - Consumer

Claims Associate - Consumer

Remote

3 Months - Contract

Notes:

Looking for Property & Casualty license

Must be bilingual English and Portuguese or Spanish

Job Description

PRIMARY PURPOSE: To provide high-quality service to both internal and external customers, delivering an easy and efficient customer experience for routine lost time.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES

Processes incoming calls, faxes and voicemails from claimants, providers, clients, attorneys, etc., resolving their claims related questions and issues in accordance with designed guidelines and policies.

Communicates claims status and current claim activity with client and appropriate medical contact; responds to inquiries about jurisdiction- and claim-specific issues.

Enters data into claims system(s) and ensures claim files are properly documented, and claims coding is correct.

Coordinates claimant address updates or changes with internal departments. Provides referrals to legal, utilization review, pharmacy, and Special Investigations Unit (SIU) as appropriate and coordinates independent medical examinations.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES

Performs other duties as assigned.

Supports the organization's quality program(s).

Education & Licensing

High school diploma or GED required.

Associate's degree from an accredited college or university preferred.

Professional certification as applicable to line of business preferred.

Experience

Two (2) years of administrative and/or customer service experience or equivalent combination of education and experience required.

Skills & Knowledge

Excellent oral and written communication skills

PC literate, including Microsoft Office products

Strong investigation and organizational skills

Good interpersonal skills

Ability to work in a team environment

Ability to meet or exceed Performance Competencies