Job Summary: 

• Acting/operating as a third party, intermediary between the Insurance Company's property adjusters, and their policyholders with respect to conducting valuations of policyholders'/claimants' total loss contents, which are most commonly caused by theft, water, fire and other perils
• Focusing on the accurate and timely processing of content claims, via the use of Edjuster’s claims handling professional service methodology and its Web-based content claims processing and pricing platform/system
• Responsible for recording all daily claims handling activity, with respect to hours worked/time spent per task as well as fulfilling all of their required administrative job duties
• Conduct a site visit to meet the adjusters/policyholders and industry vendors, where they are to explain their roles as Content Claims Specialists, and their respective roles/contributions in the claims handling process
• Visit sites to conduct an inventory of the contents lost
• Identify the claim type and apply the appropriate methodology based on the circumstances of the contents loss
• Ensure consistent and quality/turnaround of all claims in accordance with the Company’s productivity and performance standards
• Work with Central Claims Processing to organize/direct the resources for completing the inventory and LKQ assessment of all damaged/destroyed total loss contents efficiently and effectively, and as per productivity standards
• Work with Central Claims Processing to organize/direct the resources to promote/achieve the timely turnaround/closures of all claims
• Adhere to Edjuster Inc.’s commitment to timely and informative updates on the content claims process to adjusters/policyholders
• Complete/submit detailed work/time logs daily, for all claims processed
• Maintain claim-related notes in the Company’s Claims System/Web-application, eClaim, relating to incurred hours over productivity standards, as well as related to specific issues and other pertinent notes
• Ensure timely and accurate completion/pricing of all outstanding items, which have not been priced via other channels, and follow pricing Like, Kind and Quality (LKQ) standards
• Consistently promote Edjuster’s brand, image and reputation in a professional and positive manner

Skills on Resume: 

• Claim Valuation (Hard Skills)
• Data Recording (Hard Skills)
• Site Inspection (Hard Skills)
• Inventory Management (Hard Skills)
• Time Management (Soft Skills)
• Quality Assurance (Hard Skills)
• Collaboration (Soft Skills)
• Communication (Soft Skills)

Job Summary: 

• Verify insurance benefits/copays/deductibles for scheduled patients
• Document the information received in the Practice Management System and EHR
• Notify patients if there is a problem with the insurance/referral/authorizations
• Obtain referral or authorization for office visits, x-rays and minor procedures
• Minimal research regarding patient updates
• Identify the root cause of the denial and provide a denial resolution
• Handle resubmissions of corrected bills for reimbursement
• Review and research bills in which a denial of payment has been received from the payer
• Select appropriate measures for researching denials and complete the stages to resubmit bills for reimbursement
• Collect and resubmit corrected bills for reimbursement
• Pinpoint the foundation of the denial and resolve the denial

Skills on Resume: 

• Benefit Verification (Hard Skills)
• Patient Notification (Soft Skills)
• Authorization Management (Hard Skills)
• Denial Analysis (Hard Skills)
• Problem Solving (Soft Skills)
• Billing Resubmission (Hard Skills)
• Research (Soft Skills)
• Documentation Accuracy (Hard Skills)

Job Summary: 

• Handle incoming calls regarding death claim notifications
• Research the file and gather information to produce a notification letter for claims
• Examine, process, calculate and pay claims
• Process various certificate maintenance, i.e., beneficiary/owner/name changes
• Assist claimants, providers and clients with problems or questions regarding their claims and/or policies
• Analyze claims and denials by running reports and contacting insurance carriers for claim resolution
• Identify problem accounts, trends and escalate them
• Update patient account records and document any actions taken
• Generate appeals and grievance letters to explain the reasons for appeals
• Research/Identify coding or clinical issues and correct errors promptly for maximum reimbursement
• Perform all types of complex adjustments to patient accounts and resolve any issues
• Follow up with insurance carriers via phone and web portals

Skills on Resume: 

• Claim Processing (Hard Skills)
• Data Research (Hard Skills)
• Account Management (Hard Skills)
• Customer Assistance (Soft Skills)
• Denial Resolution (Hard Skills)
• Problem Identification (Soft Skills)
• Appeal Writing (Hard Skills)
• Error Correction (Hard Skills)

Job Summary: 

• Determines covered insurance losses by reviewing provisions of a policy or certificate
• Prepare claims forms and related documentation
• Record and maintain insurance claims information in a database system
• Follow-ups to the insurance companies until claim resolution
• Ensures compliance with claims procedures
• Ensures compliance with insurance companies’ policies, procedures and guidelines and regulators
• Process customers' insurance claims thru the insurance companies
• Maintaining quality customer service following the service levels established
• Protects operations by keeping claims information confidential
• Maintains a good relationship with insurance companies
• Analyze insurance claims to prevent fraud

Skills on Resume: 

• Policy Review (Hard Skills)
• Claims Documentation (Hard Skills)
• Database Management (Hard Skills)
• Follow Up (Soft Skills)
• Regulatory Compliance (Hard Skills)
• Customer Service (Soft Skills)
• Confidentiality Practice (Soft Skills)
• Fraud Analysis (Hard Skills)

Job Summary: 

• Processes claims for payments
• Requests information from internal or external sources to ensure the completeness and validity of the claim
• Answers inquiries regarding the claim
• Using customer software, sorts claims according to network status
• Enter claim information for pricing
• Maintains a high level of accuracy and production rate
• Ensure timely and appropriate investigation, evaluation, and reporting of claims
• Oversee the entire lifecycle of assigned claims following established claims handling strategies
• Work directly with the TPA and broker to investigate and expedite claims
• Work cross-functionally with all support departments to investigate Auto, General Liability, Worker Compensation, and Occupational Accident claims
• Actively participate and proactively drive improvements
• Help develop and implement product and Help Center changes to ensure a positive user experience when accidents occur and promote self-service on the platform
• Manage and oversee the DocuSign, Google/ Excel spreadsheets, and Box Folders to ensure streamlined classification

Skills on Resume: 

• Claims Processing (Hard Skills)
• Information Verification (Hard Skills)
• Inquiry Response (Soft Skills)
• Data Entry (Hard Skills)
• Accuracy Maintenance (Soft Skills)
• Claims Investigation (Hard Skills)
• Cross-Functional Collaboration (Soft Skills)
• Process Improvement (Soft Skills)

Job Summary: 

• Interviews individuals by telephone and in person, conducts initial and subsequent assessments of individual needs
• Provides in-person technical support in filing initial, additional and weekly claims for unemployment insurance benefits by guiding and coaching individuals through the filing process
• Receives and responds to telephone and/or in-person inquiries from claimants, employers, other agencies, and the general public regarding the unemployment insurance program
• Interpreting state and federal unemployment insurance laws, agency rules, regulations, policies, procedures, and guidelines
• Explains services, procedures, options, and benefits to customers
• Discusses NDOL and American Job Center services and refers accordingly
• Pre-screens claims by gathering and assessing key database information on individuals' type and location of employment and applying Nebraska, federal and state laws to make decisions
• Collects, records and stores claimant demographics and employment history, along with appropriate occupational classification codes, and enters respective data into a computer database
• Retrieves, reviews and verifies all client personal and employment information data for accuracy and completeness
• Conducts periodic eligibility review interviews with unemployed individuals regarding ability and availability for work in person and over the phone
• Reviews, batches and forwards all claims for appropriate action
• Completes and submits supplemental documentation

Skills on Resume: 

• Needs Assessment (Soft Skills)
• Technical Support (Hard Skills)
• Inquiry Handling (Soft Skills)
• Regulation Interpretation (Hard Skills)
• Service Explanation (Soft Skills)
• Data Management (Hard Skills)
• Eligibility Review (Hard Skills)
• Documentation Accuracy (Hard Skills)