|PRIMARY PURPOSE: To provide high quality service to both internal and external customers, delivering an easy and efficient customer experience for routine lost time.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
· Processes incoming calls, faxes and voicemails from claimants, providers, clients, attorneys, etc., resolving their claims related questions and issues in accordance with designed guidelines and policies.
· Communicates claims status and current claim activity with client and appropriate medical contact; responds to inquiries about jurisdiction- and claim-specific issues.
· Enters data into claims system(s) and ensures claim files are properly documented and claims coding is correct.
· Coordinates claimant address updates or changes with internal departments.
· Provides referrals to legal, utilization review, pharmacy, and Special Investigations Unit (SIU) as appropriate and coordinates independent medical examinations.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
· Performs other duties as assigned.
· Supports the organization’s quality program(s).
Education & Licensing
High school diploma or GED required. Associate’s degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
Two (2) years of administrative and/or customer service experience or equivalent combination of education and experience required.
Skills & Knowledge
· Excellent oral and written communication skills
· PC literate, including Microsoft Office products
· Strong investigation and organizational skills
· Good interpersonal skills
· Ability to work in a team environment
· Ability to meet or exceed Performance Competencies
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.