• Responds to the system’s notification and timely investigates onsite accidents.
• Checks damages on the accidental scene take pictures and proceeds as per the insurance coverage.
• Initials preliminary reports and uploads insured cars’ information onto the system.
• Adjusts functional reserves as per the degree of damages caused and uploads scanned documents within the timeframe.
• Proceeds litigants’ damage claims and transfers to the company.
• Provides customers roadside assistance.
• Ready to support out-of-scope requests.
• Communicate with related staff regarding relative matters.
• Retrieves and analyses personal KPIs for performance analysis and plans for achieving those set up objectives.
• Provide support functions to the claims department
• Sort incoming mail for distribution and dispatch outgoing mail
• Date, stamp, and sort mail according to established department policy and procedure

Skills: Accident Investigation and Documentation, Insurance Claims Processing, Claims Adjustment, Litigation Support, Roadside Assistance, Flexibility and Adaptability, Communication Skills, Performance Analysis and Goal Setting

• Execute the day-to-day operations of a health plan, including processing medical claims, researching and responding to members’ most complicated questions.
• Tracking accuracy and timeliness around core metrics.
• Troubleshooting the many operational challenges that affect business.
• Think critically and strategically to continually boost teamwork and communication across offices.
• Gain additional skills and knowledge across different areas of business over time.
• Develop in-depth industry expertise in the employer-driven healthcare economy.
• Cultivate a culture that aligns with Collective Health values and incorporates the unique aspects of team.
• Perform data entry functions
• Effectively manage workload and prioritize assignments
• Work without significant guidance
• Ensures claims inventory, outbound correspondence, and workflows are managed in accordance with State, Federal and Health plan regulatory requirements as well as departmental guidelines

Skills: Medical Claims Processing, Customer Service and Issue Resolution, Operational Efficiency, Problem Solving and Troubleshooting, Critical Thinking and Strategic Planning, Continuous Learning and Development, Industry Expertise, Cultural Alignment and Leadership, Data Entry, Workload Management

• Identify and Request Missing Documentation
• Manage the Register Log and settlement letters
• Scan incoming/outgoing claim file supports
• Document and Distribute incoming claim file support
• Claim related letters (acknowledgment, withdrawal, re-assignment)
• Triage claim-related inquiries from the service Operations team
• Package and send files to recovery and collections agencies
• Handle recovery and collection inquiries and invoicing
• Enter and process participant reimbursement requests daily in the claims processing system.
• Review participants submitted material and determine if it meets applicable guidelines for appropriate reimbursement.
• Work as a team member to achieve service levels for daily claims entry.

Skills: Claims Processing, Documentation Management, Communication Skills, Attention to Detail, Organizational Skills, Process Improvement, Customer Service, Team Collaboration

• Determine covered medical insurance benefits in accordance with the provisions of the plan document
• Establish proof of loss by studying medical documentation
• Assembling additional information from outside sources, including claimant, physician, employer, hospital, and other insurance companies
• Initiating or conducting an investigation of questionable claims
• Document medical claims processes by completing forms, reports, logs, and records
• Resolve medical claims by approving or denying, calculating benefit due, initiating payment or denial
• Ensure legal compliance by following company policies, procedures, guidelines, as well as federal insurance regulations
• Protect operations by keeping claims information confidential
• Update job knowledge by participating in educational and training opportunities, reading any required professional publications
• Accomplish organization goals by accepting ownership for accomplishing new and different requests, exploring opportunities to add value to job accomplishments

Skills: Medical Insurance Knowledge, Documentation and Proof of Loss, Investigative Skills, Information Gathering, Claims Processing, Claims Resolution, Compliance and Confidentiality, Continuous Learning and Adaptability

• Resolution of customer claims, debit notes and disputes according to specified dispute registration and claims management procedures.
• Timely investigation of claims (with all relevant departments), debit notes or disputes and the gathering of all the information needed to approve/reject claims, debit notes and disputes based on investigation.
• Effective communication and collaboration between the functions of accounts receivable credit control, cash application, customer service, finance and the claims team.
• Digital filing of all completed claims forms, documentation and proof of deliveries.
• Issuing of credit notes according to the correct authorization schedule and accompanied by all required data.
• Manage client communications regarding requests and escalations.
• Track and document daily work tasks/ issues and communicate them with the rest of the team.
• Ensuring claims are processed within the specific turnaround time 24HRS
• Ensuring confidentiality of all claims information, inclusive of claims guidelines and internal control
• Managing claims queries/complaints via phone, email and chat

Skills: Claims Management, Investigation Skills, Cross-functional Collaboration, Documentation Management, Credit Note Issuance, Client Communication, Task Tracking and Reporting, Time Management

• Knowledge of Insurance and Attention to detail
• Ability to effectively engage with clients and outside parties to maintain claims management flow.
• Problem-solving abilities including critical thinking and adaptability.
• Strong written and verbal communication skills
• Strong Microsoft Office skills and fluency with other relevant online tools
• Strong working knowledge of Excel with the ability to build and maintain spreadsheets
• Strong sense of integrity and ethics – demonstrates a commitment to the position and seeks new approaches to work within the risk management environment.
• Experience in a support or operations-type role, ideally at an insurance, start-up, or real estate company
• Strong customer service skills
• Detail-oriented and an excellent communicator (verbal/written)

Qualifications: BA in Risk Management with 3 years of Experience

• Ability to learn and apply claims policies and procedures.
• Effective written and verbal communication skills to provide information in a clear and concise manner and to communicate with a variety of stakeholders.
• Extraordinary attention to detail.
• Ability to maintain quality in a fast-paced, high-volume environment.
• A high degree of adaptability to meet changing business needs.
• Proficient in multi-tasking through various technology platforms.
• Experience in compromising in order to help the team achieve goals.
• Experience maintains healthy working relationships even in disagreement.
• An understanding of basic insurance concepts, claims, and policy coverage
• Experience in using G-Suite, Microsoft Office, Slack, and modern workplace technology

Qualifications: BA in Finance with 4 years of Experience

• Ability to work successfully in a structured fast paced team environment
• Able to manage multiple tasks at one time.
• Excellent communication skills, both oral and written.
• A high-quality/high-speed internet connection for this role.
• Advanced computer knowledge. 
• Proficient with MS Office and strong professional typing skills required.
• Ability to learn new software applications, open to experimentation with digital tools, 
• The ability to use dual monitors, and research with an analytical and curious mind will be A+ digital savvy candidate.
• Availability to work overtime with little notice.
• Paid time off to complete training and the examination.

• Ability to manage relationships in a fast-paced environment, 
• Strong problem-solving and decision-making skills to work with customers through a variety of challenging situations.
• Good analytical abilities to review, exercise judgment and evaluate claims in order to make sound decisions.
• Basic knowledge of claim procedures, policies, technology, state and federal laws and insurance regulations.
• Ability to multi-task and handle large volumes of work in a short period of time.
• Ability to communicate effectively and clearly, both orally and in writing.
• Ability to carry out detailed written or verbal instructions, ability to respond to requests effectively and efficiently and exhibit good common sense.
• Ability to work independently with self-initiative.
• Strong time management skills, organizational skills and ability to prioritize issues and tasks.
• Ability to effectively operate computer equipment and applications.
• Experience with customer service 

Qualifications: BA in Economics with 4 years of Experience

• Experience in customer service will be an added advantage;
• Good verbal and written communication skills;
• Strong team player as well as capable of individual performance;
• Excellent organizational and time management skills;
• Good interpersonal, analytical and negotiation abilities are required;
• Knowledge of life insurance policy coverage, statutes, regulations and subrogation processing is a major plus;
• High level of integrity, takes accountability of work and good attitude over teamwork.
• Takes the initiative to improve the current state of things and is adaptable to embrace new changes.
• Experience in a claim service area within the Healthcare field with an understanding of claims payment, 
• Experience processing claims, and answering claims CCHP temporary experience within the Claims Department.
• Excellent Customer Service Skills with ability to explain complicated claim issues to providers.
• Ability to resolve conflict.

Qualifications: BA in Insurance Studies with 5 years of Experience