Claim Operations Specialist

Claim

Compensation Overview

The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.

Salary Range

$44,200.00 - $72,800.00

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Under moderate supervision, this position is responsible for partnering with claim professionals to assist customers. Responsibilities within the team include building customer relationships, completing financial transactions, updating and managing important business information, and handling numerous other duties and projects. This position does not manage others. As part of the hiring process, this position requires the completion of an online pre-employment assessment. Further information regarding the assessment including an accommodation process, if needed, will be provided at such time as your candidacy is deemed appropriate for further consideration.

What Will You Do?

• CUSTOMER ENGAGEMENT: Serves as a customer service representative for the claim department by promptly and professionally addressing customer questions and concerns, which may include: Triage and route callers to the appropriate department; Answers claim status and payment questions.
• CLAIM OPERATIONAL SERVICE AND PARTNERSHIPS: Partners with claim professionals in multiple departments to assist with the timely resolution of claims, which may include: Properly documents claim files, including notes and diaries, Requests reports and records, and reviews medical bills, mail and wage statements. Prints and prepares claim documents for legal and medical reviews. Reports and assigns claims, and transitions closed files to and from off-site storage. Receives, sorts, scans, and uploads incoming mail, and processes out-going mail. Orders, receives and distributes supplies and/or equipment.
• CLAIM PAYMENTS AND EXPENSE PROCESSING: Ensures the proper handling of financial transactions to include: Processes and issues claim payments including outside vendor invoices, attorney expenses, and medical processing fees. Processes and documents returned checks, voided checks and credits. Ensures timeliness and accuracy of all check processing.
• DATA AND INFORMATION MANAGEMENT: Maintains accurate records and information management, such as: Prepares, generates and reviews reports using the most effective technology. Updates data discrepancies identified in reports and systems. Uses management information data to prepare line of business or financial reports. Prepares operational reports for claim professionals and managers. Accurately documents pending and completed work activities using appropriate systems.
• FINANCIAL CONTROLS AND ASSESSMENTS: Assists with claim center financial standards, including: Performs underlying controls and effectively communicates findings. Assesses the reasonableness of data as well as identifying discrepancies, including reconciliations. Assesses the effectiveness of financial controls. Prepares data entries in accordance with established standards.
• May require lifting items up to 20 pounds (occasionally).
• Other duties as assigned.
• Perform other duties as assigned.

What Will Our Ideal Candidate Have?

• Experience utilizing computer technology such as Microsoft Office, e-mail, Web-enabled applications, and database software.
• ACCOUNTABILITY: Takes ownership and responsibility for actions and outcomes, performance and results.
• ANALYTICAL THINKING: Ability to analyze and compare information to understand issues and explore alternative solutions.
• CHANGE MANAGEMENT/RESILIENCE: Ability to remain energized and focused in the face of ambiguity, change or strenuous demands.
• COMMUNICATION SKILLS: Verbal and written communication skills.
• JUDGMENT/DECISION MAKING: Ability to exercise sound judgment and make decisions.
• RELATIONSHIP MANAGEMENT: Ability to seek out, build, foster and maintain productive working relationships to meet goals and achieve results.

What is a Must Have?

• High School Diploma or GED.
• 1 year of service-related work experience OR Bachelor’s Degree required.