• Process Professional and Hospital claims accurately and timely within the claiming system
• Process claims according to set guidelines for payment or denial
• Price claims according to Medicare, Medicaid and custom fee schedules
• Meet personal and team goals and metrics
• Manually enter data from CMS1500 and UB04 claims into the claiming system as necessary
• Use available resources to manage workload
• Actively participate in staff meetings
• Communicate with supervisor on workload/issues/backlog
• Follow procedures, guidelines and policies
• Provide customer support for a 1-800 line inquiries
• Participates at Product Management, Tech Support, and Claim Handler events when needed (e.g. Tech Days, Sales Conference, etc.)
• Increases Brand Awareness and Gates' loyalty through service to the customer.

Skills: Claims Processing, Pricing Expertise, Goal Achievement, Data Entry, Workload Management, Communication Skills, Adherence to Policies, Customer Service

• Provide excellent customer service to members and clients.
• Review inbound fax/email/mail and proactively work to resolve customer claims in a timely fashion.
• Compares data on waiver requests or claim forms with membership plan to ascertain completeness and validity of the request. 
• Examines waiver request or claim form and other records to determine member benefits.
• Proactively works to resolve waivers and claims as expeditiously as possible.
• Reviews and analyze detailed records. 
• Calculates benefits according to the schedule of coverage.
• Cultivates relationships and increase productivity without jeopardizing quality.
• Approves waiver requests and claims at the appropriately demonstrated assigned authority level.
• Handles incoming warranty requests and processes service requests for warranty within the plan provisions.

Skills: Customer Service Excellence, Claims Processing, Attention to Detail, Benefit Calculation, Analytical Skills, Decision Making, Productivity Improvement, Warranty Processing

• Obtains information from involved parties to evaluate the injury portion of claims, including treatment records, medical bills, wage loss statements, and mileage payments and to determine benefits eligibility
• Review coverage and claims process with injured party(s)
• Evaluates medical records and treatment plans to determine if continued treatment is reasonable
• Sets reserves, documents injury and treatment information and may make referrals to SIU
• Researches and responds timely to customer inquiries and/or concerns throughout the life of a claim to ensure customer satisfaction and retention
• Monitors course of treatment, reviews medical bills for duplicate charges and submits requests for payment of claims to Supervisor
• Submits files to Supervisor for audit upon closing
• Identify and escalate files with more significant indemnity exposure to Supervisor for review/transfer for further investigation
• Reviews and processes claim edits/rules for accuracy as well as insurance and coding compliance.
• Maintains less than 5 day lag from create date for aging of edits.
• Completes Charge Entry within 5 business days of receipt.
• Audits chart notes for documentation to support coding.
• Serves as resource/mentor to Charge Capture Specialists including training of new processes
• Trains new hires, clinical staff (EMR service order entry), clerical staff (ETM processes) including troubleshooting

Skills: Medical Claims Evaluation, Coverage and Claims Knowledge, Medical Records Review, Reserve Setting and Documentation, Customer Service and Satisfaction, Claims Processing and Audit, Compliance and Accuracy, Training and Mentorship

• Responsible for responding to and timely investigation/resolution of all incoming calls received on designated customer service lines in accordance with policies and procedures. 
• Analyze claims and approve or deny claims for payment by ensuring the fees are correct, verifying the proper authorizations were submitted, and resolving hold codes. 
• Ensure the validity of claims by reviewing claim forms and attached documentation,
• Verifying the accuracy of information entered into the claims processing application, and reviewing claims for potential secondary-coverage issues.
• Ensure claims are processed timely in accordance with the HMO and CMS guidelines.
• Recommend opportunities for decreasing claims-related customer service calls by reporting any trends to CHS management.
• Record and document calls and resolution using the related system modules, and adding notes to claims and / or member records, when applicable.  
• Follow procedures for call documentation in accordance with established policy.
• Maintain all necessary levels of member/patient privacy in accordance with HIPAA standards which includes identify any caller requesting PHI before disclosing information, 
• Ensure proper authorization has been received, and provide limited information only on a “need to know” basis.

Skills: Customer Service, Claims Analysis, Claims Processing, Regulatory Compliance, Problem-Solving, Documentation and Record-Keeping, HIPAA Compliance, Attention to Detail

• Processes claims for more complex ceding companies, including approving claims up to authority limit and reviewing assigned non-routine claims so that payments fulfil treaty agreement obligations and meet department processing standards.
• Supports subordinate team members with technical expertise on the completion of auxiliary tasks, and resolution of non-routine client matters, and provides guidance and/or training as required so that claims are processed within accuracy and time standards.
• Works independently to complete non-routine administrative tasks to support Management. 
• Coordinates with Claims team, or on cross functional teams, for completion of tasks assigned so that the department operations and deliverables are supported and objectives are met. 
• Develops and maintains professional client relationships so that the Hannover Re brand values are employed.  
• Work closely with the strategic claims team to help it embed best claims practices that has been identified through its own QA work and that of reinsurers and the internal group risk and compliance team.
• Work with the strategic underwriters, management, reinsurers, and other stakeholders to ensure the swift and correct outcome of a claim.
• Provide feedback to the claims assessors about better ways of claims assessment in line with best practices. 
• Discussing cases to demonstrate best claims practice and how this compares to current ways of working.
• Training sessions with the claims assessors to help improve current claims assessment practice, knowledge and technical skills.
• Assist with QA checking of completed claim assessments.

Skills: Claims Processing Expertise, Technical Support and Guidance, Independent Task Management, Team Coordination, Client Relationship Management, Integration of Best Practices, Feedback and Improvement, Training and Development

• Experience working within a customer service delivery role particularly in Insurance or Financial Services advantageous
• The ability to build strong relationships
• Ability to be exposed to general insurance or claims processing
• An aptitude to solve problems and sound decision-making capabilities
• Excellent communication and customer service skills
• Computer literacy is highly advantageous
• Detail-oriented, with solid organizational, problem-solving, and administrative skills
• Strong written, visual, and verbal communication skills
• Team-oriented with a strong willingness to serve others and the ability to deliver superior customer service
• Possesses initiative and thrives in a fast-paced work environment
• Ability to embrace technology and adapt to a changing environment

Qualifications: BA in Business Administration with 2 years of Experience

• Problem-analysis and problem resolution skills
• Interpersonal and communication skills
• Knowledge of insurance coverages, laws and regulations.
• Ability to travel approximately two days per month
• Ability to organize, prioritize and manage multiple tasks in a fast-paced environment
• Quickly and professionally respond to inquiries from customers
• Ability to communicate effectively with all levels of the organization
• Ability to manage a project and/or lead a team. 
• Regularly and consistently demonstrates commitment to company values and guiding principles.
• Experience in insurance, claims handling and working in different language.
• Very good knowledge of English (DSV corporate language).
• Knowledge of German language (will be an advantage).
• Knowledge of Scandinavian language (will be an advantage).
• Knowledge of MS Office

Qualifications: BS in Health Administration with 3 years of Experience

• Strong interpersonal skills with ability to collaborate and work effectively with individuals, strengthening relationships to achieve best possible solutions
• Problem-solving and strong initiative are super important
• Ability to understand client and business partner needs and challenges and apply creative and logical approach to identify solutions
• Strong attention to detail while managing multiple concurrent project deadlines
• Experience with customer service  in retail, restaurant, or other business situations
• Strong proficiency in Excel and other Microsoft Program skills required
• Comfort and confidence when interacting with internal and external partners and clients/customers
• Proven experience going the extra mile to solve complex customer inquiries via extensive research
• Basic knowledge in computer software programs and office equipment
• Excellent verbal and written communication skills
• Negotiation skills, ability to work under time pressure and communication, interpersonal skills, proactive mindset
• Ability to take ownership and drive processes and ability to prioritize.

Qualifications: BA in Psychology with 4 years of Experience

• Experience in managing end-to-end general insurance claims
• Possesses skills for independent and qualitative task completion with excellent time management and organisational skills, and attention to detail
• Exceptional literacy, numeracy/data, and written and oral communication skills
• Excellent analytical skills, and a proven ability to negotiate effectively
• Able to adhere to business processes, key performance indicators and timelines
• A strong focus on exceptional customer service with a genuine desire to help people
• Experience in direct LTD disability claim management
• Experience in complex LTD claim management
• Exceptional claim/risk management skills and technical knowledge in contract interpretation and administration
• Demonstrated success at coaching others to elevate performance
• Demonstrated leadership skills in other positions
• Strong presentation and facilitation skills

Qualifications: BA in Finance with 3 years of Experience

• Experience in a health-related field (an asset)
• Excellent Written and Verbal Communication Skills
• Excellent Interpersonal Skills
• Superior Organizational Skills and Time Management skills
• Ability to Demonstrate effective negotiation skills
• Demonstrated abilities using estimating software such as Xactimate and desk adjusting to settle claims.
• Experience on a Property team handling field claims
• Experience in construction, restoration, or claims
• Proficiency in Microsoft Windows, Office 365, Word, and Excel
• Experience in claims handling/reporting 
• Basic knowledge of P&C insurance coverage
• Familiarity with AMS360
• Exceptional telephone demeanor
• Exceptional customer service and interpersonal skills

Qualifications: BA in Communication with 4 years of Experience