Claims Processing Associate

Job Description

SUMMARY :

This role will focus on maintenance of our incoming workload, issue resolution and first report of injury (FROI) issues. This position determines jurisdiction for entry of first notice of injury (FNOI) from multiple sources and distributes to the proper destination. Enters and supports priority and special requests, including correcting newly-created claims.

PRIMARY RESPONSIBILITIES : (Brief bullet points detailing the major duties, not tasks, for this job and the % of time spent on each. Please list them in the order of importance).

• Identifies jurisdiction, date of injury and special / additional handling items; researches and re-indexes non-new claim submissions to route to appropriate handling.
• Receives incoming general new claims calls for all entities; backup for ACD calls in the event of telephone system shutdown.
• Makes changes, corrections and updates on newly created and / or existing claims or submissions as well as guiding end-users on process techniques in various applications.
• May serve as a resource regarding intake-related issues, i.e., determine jurisdiction, assist in clearing policy issues to process claim; in finding coverage or other information.
• May participate in training employees new to the role.
• Processes Workers' Compensation claims retrieved from Open Pool queues or via telephone; codes body part, diagnosis and cause of injury by entering submitted data in the claims system reviews claim for accuracy prior to completion and performs all tasks specified for state-specific requirements after claim setup.
• Confirms policy coverage for date of injury, business location and injury location; requests policy update for locations as needed.
• Maintains department procedures, working instructions and job aides; may participate in creating new workflows or workflow changes.
• Researches multiple state and internal systems and documents and routes / or indexes incoming mail to appropriate region and / or department from unidentified mail queue.
• Forwards unidentified mail to sender using appropriate form letters.
• Routes documents to medical bill review vendor.

This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS :

A. EDUCATION REQUIRED :

High school diploma or G.E.D.

B. EXPERIENCE REQUIRED : (Minimum experience required to perform this job) Do not state preferred experience.

Minimum of two years of general office experience, including customer service experience that provides the required skills, knowledge and abilities.

C. SKILLS / KNOWLEDGE / ABILITIES (SKA) REQUIRED :

D. ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND / OR ABILITIES PREFERRED :

WORKING CONDITIONS :

Work is performed in an office setting with no unusual hazards. Work may be performed at varied hours / days / shifts.

REQUIRED TESTING :

Basic Word, Basic Excel, Basic Windows, Reading Comprehension, Alphanumeric Data Entry, and Proofreading