Job Summary:

• Acts on behalf of Health & Welfare Claims Senior Manager in his absence (directs work of other staff, decision making).
• Manages claims staff including leads and processors.
• Oversees the processing of specialty claims including third-party claims, death benefits, PPOC, MSPRC, and hospital claims.
• Tracks and updates daily individual and department claim processing statistics to manage quality assurance, employee performance, and work distribution.
• Recommends improvements to policies, standard operating procedures, and workflows to meet department performance, quality, and member goals, and implements as directed.
• Manages and provides performance feedback, guidance, training, motivation, performance appraisals, and support to staff.
• Participates in employee engagement action planning and execution or experience in driving employee engagement to meet or exceeding company expectations.
• Delivers performance coaching and training to assigned staff, including claims processing staff in order to accomplish the organization’s goals.
• Enforce Office Policies, Collectively Bargained Agreements, State Law, and Federal Law in managing non-exempt collectively bargained employees.
• Completes time cards to ensure that are completed timely, accurately, in accordance with office policies, Collectively Bargained Agreements, State Law, and Federal Law for non-exempt collectively bargained employees.
• Participates in the phone interview process for the hiring process, new employee orientation and training ensures the timely development of performance appraisal, 
• Communicates job expectations, enforces policies and procedures, coaching, and administers discipline.

Skills on Resume: 

• Leadership and Supervision (Hard Skills)
• Claims Processing Expertise (Hard Skills)
• Performance Management (Hard Skills)
• Process Improvement (Hard Skills)
• Employee Development and Engagement (Soft Skills)
• Coaching and Training (Soft Skills)
• Compliance Management (Hard Skills)
• HR and Recruitment (Hard Skills)

Job Summary:

• Communicates department-level quality assurance and improvement goals as well as individual adjustor quality improvement expectations.
• Participates in data validation, coordinates,s and participates in the testing of upgrades and enhancements of the current software. 
• Participates in creating testing scenarios to ensure upgraded programming matches Summary Plan Description language. 
• Review of system upgrades or annual system workflows.
• Coordinates and communicates with vendors to troubleshoot and resolve issues that prevent the finalization of claims.
• Coordinates staffing and work assignments with other Supervisors as necessary.
• Responds to elevated calls from members, providers, and union representatives. 
• Responds to and resolves more complex or sensitive complaints/issues. 
• May assign call back to staff for research and follow up or elevate a call to Health & Welfare Claims Senior Manager if necessary. 
• Oversees follow-up process until all inquiries/issues are resolved.
• Directs staff on how to resolve routine and non-routine claims issues
• Provide training and guidance to junior staff.
• Prepare reports by management.

Skills on Resume: 

• Communication Skills (Hard Skills)
• Data Validation and Testing (Hard Skills)
• Problem-Solving and Troubleshooting (Hard Skills)
• Process Improvement (Hard Skills)
• Leadership and Supervision (Soft Skills)
• Customer Service (Soft Skills)
• Training and Development (Soft Skills)
• Reporting and Documentation (Soft Skills)

Job Summary:

• Prepares memos, emails, and other communication to address claim functions.
• Assists in the development of tools to assist staff in efficiently providing quality service to members.
• Trains staff on completing and processing all claim types. 
• Provides additional training and support to staff
• Clearly communicates changes in policy and procedure that affect claims paperwork.
• Monitors the open enrollment and special reports to ensure claims information is accurate. 
• Reconciles discrepancies or assigns and supervises staff to reconcile discrepancies.
• Participates in open enrollment planning meetings.
• Reviews member communications and assists with testing online products to ensure the information is easy to understand and complies with the appropriate laws, regulations, and eligibility requirements.
• Participate in company education fairs.
• Participate in project development and implementation.

Skills on Resume: 

• Written Communication (Hard Skills)
• Tool Development (Hard Skills)
• Training and Development (Hard Skills)
• Monitoring and Reporting (Hard Skills)
• Discrepancy Resolution (Hard Skills)
• Compliance and Testing (Hard Skills)
• Policy and Procedure Communication (Soft Skills)
• Meeting Participation (Soft Skills)

Job Summary:

• Ensure claims are processed in accordance with the Company’s Claims Service Standard and/or Bank Negara’s Guidelines on Claims Settlement Practices.
• Provides quality (prompt and fair) claims services to meet customer satisfaction.
• Compliance with all claim processes, procedures, policies, and guidelines as stipulated in the Claims Manual and/or instructions.
• Work proactively to develop and manage strong relations with various stakeholders i.e. policyholders, marketers, agents, underwriters, co/reinsurers, finance department, and others.
• Assists in organizing workflow and allocation for effective handling of claims. 
• Ensure that policies, procedures are followed, service standards maintained, and claims data processing input are accurate and maintained at a high standard.
• Review/follow up on all outstanding claims on a regular basis to ensure claims reserves are adequate and status updated. 
• Maintain a low pending ratio of outstanding claims (prompt disposal of claims to reduce the number of outstanding claims.)
• Identify any deficiency on policy coverage, issues, and adverse claims trends so that corrective measures can be taken.
• Process all incoming inquiries, review complaints, and appeal claims within the turnaround time, service standard, and in accordance with all regulators.
• Handle FMB/ BNM referred cases, sOX audit

Skills on Resume: 

• Claims Processing Expertise (Hard Skills)
• Customer Service Orientation (Soft Skills)
• Compliance Management (Hard Skills)
• Stakeholder Management (Soft Skills)
• Workflow Organization (Hard Skills)
• Accuracy and Data Management (Hard Skills)
• Claims Review and Monitoring (Hard Skills)
• Problem Identification and Resolution (Hard Skills)

Job Summary:

• Maintain tracking spreadsheets to keep information up to date on pending retired and non-recoverable cases.
• Adheres to the Health Information Portability and Accountability Act (HIPAA) on the release of patient information to third parties.
• Coordinate with the Staff Judge Advocate Office and the payer to resolve non-payment or reduced payment issues.
• Consolidates and validates information on the injury reports, researches medical data registry for proof of eligibility, verifies appointments
• Ensure document flow and proper processing of medical affirmative claims.
• Conduct research on radiobiology, laboratory and pharmacy charges for additional billing needs.
• Working in a paperless environment
• Assisting with file assignment and all tasks related to intake and distribution to internal and external counsel
• Conflicting of referrals to determine if any barrier to assigning files to counsel
• Maintaining file assignment intake log and Contact Claims litigation screens
• Word Processing, electronic filing and general office duties
• Adapt to the evolving changes related to the file referrals process

Skills on Resume: 

• Attention to Detail (Hard Skills)
• Knowledge of HIPAA Regulations (Hard Skills)
• Conflict Resolution (Hard Skills)
• Data Management and Validation (Hard Skills)
• Claims Processing (Hard Skills)
• Medical Billing Knowledge (Hard Skills)
• Proficiency in Electronic Systems (Hard Skills)
• Adaptability (Soft Skills)

Job Summary:

• Report high volume of Property, G/L, Umbrella/XS & Auto claims to appropriate carriers
• Obtain GL claim status updates from the carrier examiners and create spreadsheet reports
• Review policies to confirm coverage prior to reporting a claim
• Interact with adjusters to obtain statuses on Property & Auto claims
• Settle small 3rd Party Property claims (up to a $1500 limit) for large client
• Forward Summons & Complaints to adjusters and ensure assignment of counsel
• Review policies to determine which defendants are entitled to coverage under the insured’s policies
• Interact with clients to obtain claim details and address general questions
• Assist claim management and designated Hub examiners on projects and day to day reporting
• Providing Support to Legal Managers, assistants, clerks, lawyers and management

Skills on Resume: 

• Claims Reporting (Hard Skills)
• Data Management (Hard Skills)
• Policy Review (Hard Skills)
• Claims Communication (Hard Skills)
• Legal Support (Hard Skills)
• Client Interaction (Soft Skills)
• Project Management (Soft Skills)
• Compliance and Documentation (Hard Skills)

Job Summary:

• Receive and review the first notice of loss and enter preliminary notice data into the claims system
• Identify and triage high-severity matters which may require expedited review
• Draft and send form letters and other communication to internal and external customers.
• Assist with defense counsel onboarding for the online billing system
• Assist adjusters with various administrative tasks including coordinating meetings, booking travel, and answering phone calls
• Assist adjusters in complying with various professional liability claim reporting requirements
• Maintain and compile various monthly and quarterly reports including ad hoc reports
• Maintain trial calendar and mediation calendar for claim department
• Undertaking routine claims handling, including personal injury matters, cargo claims, and pre-load steel surveys
• Monitoring and progressing the setting up of claims on Milan once incidents have been created
• Maintaining a log of safety and loss enquiries dealt with by the claims team
• Ensuring that incoming messages are EDMS'ed for members of the claims team

Skills on Resume: 

• Claims Processing (Hard Skills)
• Severity Triage (Hard Skills)
• Communication (Hard Skills)
• Administrative Support (Hard Skills)
• Compliance Assistance (Hard Skills)
• Reporting (Hard Skills)
• Calendar Management (Hard Skills)
• Document Management (Hard Skills)

Job Summary:

• Update of the claims reported by WH and CS.
• Reporting Claims Weekly  (Excel).
• Coordinate with different departments (CS, OCC, Finance) to obtain the documents required by the Insurance Company.
• Preparation of claim letters, credit notes, etc.
• Participate in Claims Meetings with UK and FR Managers. 
• Participate in Claims Meetings with Insurance Broker. 
• Assist to manage the Group Insurance Policies.
• Assist department, claims handlers and external legal firms with questions or help they made need in relation to legal accounts, billing platform or any of the objectives of the Litigation Management Department
• Work in collaboration with members of the Litigation Management team, requisitioning payments to ensure accurate and timely payments in compliance with Intact’s service level expectations
• Work in collaboration with members of the Litigation Management team, assisting with the management of litigation billing software to ensure accuracy and integrity of the system
• Support the Managers and Director of the Litigation Management Department with special projects and assignments

Skills on Resume: 

• Excel Proficiency (Hard Skills)
• Coordination Skills (Soft Skills)
• Document Preparation (Hard Skills)
• Meeting Participation (Soft Skills)
• Insurance Policy Management (Hard Skills)
• Legal and Billing Support (Hard Skills)
• Project Support (Soft Skills)

Job Summary:

• Sets up new claims in system, ensuring all documentation is present and correct.
• Prepares, schedules, and processes payment vouchers on claim files as directed by the Claims Examiner and/or Supervisor.
• Documents all work product and claim activity in the electronic claim file.
• Prepares and prints letters and sends via select method of delivery per claim examiner instruction
• Provides clerical support, including accounting, filing, faxing, sorting, photocopying, and alphabetizing.
• Communicates pertinent claim information to the client, legal counsel and internal claims staff.
• Answers phone calls, take messages and responds appropriately to requests for assistance.
• Index and process mail and invoices.
• Issue payments as requested by managers.
• Research payments, claim details and provide reports on special projects.
• Provide file copies and other support functions for litigation and the claims floor in general.
• Undertake projects/ other tasks allocated by management
• Conduct annual claims workshop

Skills on Resume: 

• Claims Processing (Hard Skills)
• Payment Processing (Hard Skills)
• Documentation Management (Hard Skills)
• Correspondence Handling (Hard Skills)
• Administrative Support (Hard Skills)
• Communication Skills (Soft Skills)
• Customer Service (Soft Skills)
• Data Management and Reporting (Hard Skills)

Job Summary:

• Processing claims for and against the Client under the guidance of the Insurance Claims Coordinator
• Supporting the Insurance Claims Coordinator by investigating and communicating results to the Client
• Maintaining the asset registers of Red & Green claims
• Taking and actioning calls through the Emergency Response Line in connection with defects/incidents arising on the network during working hours
• Receiving information from colleagues regarding out-of-hours incidents
• Supports senior claims staff in a wide variety of tasks, including assisting with claim files, preparing materials for internal and external audiences, reviewing and sending correspondence
• Prepares and processes claim and expense payments for the claim department.
• Handles various administrative tasks including maintaining and ordering office supplies, and assisting with travel and expense reporting.
• Anticipates and meets all customer needs (internal and external).
• Review and process billing must coordinate with bill review on this task.
• Provide backup support for the mailroom

Skills on Resume: 

• Claims Processing (Hard Skills)
• Investigation and Communication (Hard Skills)
• Asset Register Maintenance (Hard Skills)
• Emergency Response (Hard Skills)
• Handling Out-of-Hours Incidents (Hard Skills)
• Administrative Support (Hard Skills)
• Payment Processing (Hard Skills)
• Customer Service (Soft Skills)