• Obtaining the facts of the claim and reviewing coverage.
• Reviewing estimates, appraisals, police reports, medical bills and other documents.
• Clear and professional communication with customers, agents and vendors.
• Frequently making and receiving phone calls.
• Working within authority to timely and appropriately resolve claims, and working with the management team on claims that exceed authority.
• Using a variety of software to manage work and document the claim file.
• Active participation in a variety of team meetings and training.
• Regular collaboration with teammates and the department.
• Have conversations with the manager to discuss role, goals and development plan.
• Convey training opportunities from customer and other contacts to management.
• Respond to all email and phone calls from customers in a timely manner

Skills: Claims Investigation and Coverage Review, Document Review and Analysis, Effective Communication, Phone Communication Skills, Claims Resolution, Software Proficiency, Team Collaboration, Customer Service Excellence

• Perform all duties of a Claims Administrator in support of department and Masco Claims as required.
• Interact with consumers (Pro and DIY) and provide technical information to resolve complex product matters/concerns.
• Send correspondence to customers and explain denials where applicable
• Maintain updated case files for all assigned claims (track cases from the time received to final resolution).
• Collect and maintain pertinent claim documentation – statements, reports, photos, estimates, releases, etc.
• Assist Masco Claims by providing technical knowledge and claim support as required to assist in resolving complex property damage and bodily injury claims.
• When necessary, coordinate inspections by third party administrator to collect information required for the claim evaluation process.
• Develop, maintain and coordinate architectural specifications, label analyses and other product guides as assigned.
• Keep abreast of product and service developments to include
• Marketing memos, new products, product changes, product label updates, brochures, MSDS, online guides and other resource materials.
• Assist other department processes, functions and administrations that will support customer satisfaction and achievement of departmental goals, protect the brand and protect shareholder interests.

Skills: Claims Administration, Technical Support, Communication Skills, Documentation Management, Technical Knowledge, Coordination and Collaboration, Technical Writing, Product and Service Knowledge

• Receives claim information from Lockton client and verifies current insurance coverage.
• Reports claim information accurately and promptly to the appropriate insurance carrier on behalf of the client
• Mails and/or faxes claim information to the insurance carrier.
• Enters claim and coverage information into computer system by using alpha-numeric keypad.
• Manages the progress of the claim until conclusion.
• Maintains communication with Lockton client and insurance carrier
• Prepares status reports on critical claims for client.
• Meets with Producer and Commercial Insurance Department associates concerning claims progress.
• Fields all questions and acts on requests concerning claim progress
• Handling daily mail, paying special attention to checks/drafts and items requiring immediate attention.
• Protects the confidentiality of information learned by performing the duties of the position.
• Makes positive contribution to customer satisfaction and constantly strives to improve service to the customer.

Skills: Insurance Claims Processing, Data Entry and Computer Skills, Claim Management, Communication Skills, Reporting and Documentation, Client Relationship Management, Attention to Detail, Confidentiality and Compliance

• Process manual claims, consistently meeting productivity and quality standards.
• Verify eligibility of member and status of accounts.
• Enter appropriate claims into claims platform, confirm accuracy of result and make appropriate changes if necessary
• Keep management informed of actual or potential system or procedural problems, plan set-up questions and need for system corrections to accurately process claims.
• Correctly process returns for any claims that cannot be entered into the system.
• Work with management to address escalated issues or claims with problems.
• Adhere to all individual employee performance standards including productivity, quality and attendance.
• Adhere to all company and departmental policies and procedures
• Interact and support the CID departments with claim summary information as well as claim data
• Responsible for collecting client’s claims data from various insurance carrier or TPA RMIS Systems

Skills: Claims Processing, Quality Assurance, Eligibility Verification, Data Entry Accuracy, Problem Solving, Customer Service, Adherence to Standards, Compliance

• Review claims and payments for accuracy and adherence to correct coding and billing standards.
• Determine amounts and charged to be billed, patient portion due, and apply discounts according to payer rules and policies.
• Ensure the accuracy of data.
• Maintain strict personal, customer, and company confidentiality.
• Navigate simple to complex insurance claim-related losses, including mediating resolutions and disagreements between owners and renters, through the entire claim cycle.
• Work closely with all departments, from fellow claims & resolution team to RVezy's co-founders, to align on case strategies.
• Provide input, and ideas, and brainstorm on topics relevant to operations and customer success
• Craft clear and concise resolution plans to ensure fair and accurate outcomes on all claims.
• Collaborate with insurance providers and third-party vendors in order to bring a successful resolution to claims and disputes.
• Identify possible risks, and work with other departments to de-escalate situations wherever possible.
• Responsible for the submission, oversight, and management of all assigned insured claims from onset to conclusion.
• Implements Company policy and procedures for the reporting, handling, and oversight of insured claims.
• Ensures the reserve for each claim is accurate.

Skills: Claims Review and Billing Accuracy, Data Accuracy and Management, Confidentiality Maintenance, Claims Resolution and Dispute Management, Cross-Functional Collaboration, Policy Implementation and Compliance, Vendor and Provider Collaboration, Risk Identification and Mitigation

• Represent claimants in Social Security cases pending at the initial and appeal levels until/unless a hearing is scheduled. 
• Interprets Social Security statutes and regulations and applies to facts of each case.
• Analyzes existing medical evidence and determines additional medical records necessary to demonstrate proof of Social Security disability.
• Recommend closure or OTR to lead developer based upon evidence of record.
• Analyze SSA/DDS/OHO requests and determines appropriate response.
• Obtains status from SSA/DDS/OHO.
• Files Reconsiderations and Hearing Requests within specified timeframes.
• Assists claimants in completing DDS questionnaires.
• Completes initial applications for Social Security benefits with claimants.
• Fields claimant and client company calls and determines next steps based on information obtained, SS law and process and GENEX internal process and procedures. 
• Documents all claim activity in departmental database.

Skills: Interpreting Social Security Statutes and Regulations, Analyzing Medical Evidence, Managing Case Progression, Advocating for Claimants, Assisting with Documentation, Ensuring Compliance, Decision Making on SSA/DDS/OHO Requests, Client Communication and Support

• Experience in customer service via phone or e-mail communication
• Experience in Microsoft Office products (Outlook, Word and Excel)
• Experience in following a business plan
• Accomplishes tasks according to the directions and instructions provided
• Experience in providing excellent service to internal and external customers
• Demonstrates a strong attention to detail
• Experience in reviewing information and consistency
• Experience in communicating both verbally and in writing
• Experience in communicating messages, thoughts, and ideas to others
• Demonstrates strong presentation skills
• Experience in maintaining a steady and positive attitude in challenging situations
• Experience in handling rejection and criticism well

Qualifications: BA in Business Administration with 3 years of Experience

• Knowledge of commercial property/casualty coverages as it relate to the claim process. 
• Experience in commercial claims 
• Ability to organize and prioritize heavy workload to meet deadlines, and to work under time pressure.
• Ability to compile and analyze appropriate data.
• Proficient with MS Office suite of software including Excel, and Word.
• Ability to complete continuing education requirements as needed
• Ability to attend company, department, and team meetings as required, including industry training sessions
• Ability to comply with all company policies and procedures, proactively protecting the confidentiality of Client and company information
• Ability to efficiently organize work and manage time in order to meet deadlines.
• Ability to use office equipment such as a computer, keyboard, calculator, photocopier, and facsimile machine

Qualifications: BA in Communication with 2 years of Experience

• Knowledge of computerized claims systems, 
• Knowledge of organization structure of MCO claims processing, methods, and procedures utilized in claims processing, medical terminology, third-party reimbursement, and coordination of benefits.
• Ability to process moderate to more complex claim issues.
• Knowledge of Microsoft Office applications, including Excel, Word, and Outlook.
• Experience in medical claim payment or medical billing processing
• Experience in Medicaid/Medicare claims 
• Experience in MCO claims payment-processing 
• Able to prioritize and plan work activities, use time efficiently and develop realistic action plans.
• Actively promote and personally observe safety and security procedures and use equipment and materials for ONR business use only.
• Strong communication and interpersonal skills necessary to handle fast-paced situations and interact professionally and courteously with all personnel and vendors.

Qualifications: BA in Finance with 3 years of Experience

• Professional communication skills (verbal, listening and written)
• Ability to tactfully present information in clear and understandable manner.
• Ability to analyze contracts, interpret metrics and understand workflows.
• Ability to work with complex claims.
• Ability to adapt to change and willingness to take on new tasks.
• Ability to utilize Microsoft Office applications, databases, EHR and practice management software, as well as, internet applications.
• Ability to prioritize and efficiently process claims
• Ability to work independently with a high level of professionalism, dedication and commitment.
• Ability to meet deadlines and hold vendors accountable to service level agreements.
• Interpersonal and relationship-building skills
• Ability to establish and maintain positive working relationships, internally and externally.
• Ability to be receptive and open to regular feedback as provided, to enhance and develop performance.

Qualifications: BA in Psychology with 4 years of Experience

• Excellent verbal and written communications skills.
• Knowledge and experience with Word, Excel and Outlook required.
• Ability to work on multiple projects at one time
• Ability to work under pressure and to deadlines.
• Must have demonstrated attention to detail and accuracy with a working knowledge of medical billing processes.
• Ability to multi-task and possess strong administrative skills.
• Able to communicate effectively by telephone, e-mail, and in person with customers, co-workers, and supervisors
• Able to synthesize complex or diverse information.
• Able to identify and resolve problems in a timely manner and gather and analyze information skillfully.
• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Qualifications: BS in Healthcare Administration with 2 years of Experience

• Experience in technical and customer service work within a technical services environment
• Strong clerical/data entry skills
• Experience in applied EPIC 
• Strong attention to detail
• Proven negotiation skills
• Strong verbal and written skills are required.
• Able to manage both financial and people resources.
• Keep abreast of crop insurance industry claims standards and legal requirements.
• Able to read, analyze, and interpret legal and policy information.
• Able to look for ways to improve and promote quality and demonstrate accuracy and thoroughness.

Qualifications: BA in Criminal Justice with 3 years of Experience