What are the responsibilities and job description for the CLAIMS COORDINATOR position at Divers Alert Network?
POSITION OVERVIEW
FLSA: Exempt, Full Time
Department: Claims
Primary Worksite: 6 West Colony Place, Durham, NC
Supervisory Responsibilities: None
Reports to: Vice President, Claims and Assistance Services
Salary: $45,000 – $55,00
JOB SUMMARY
The Claims Coordinator is responsible for overseeing and efficiently processing member benefit and insurance claims. You will work closely with insurance carriers, members, and healthcare providers to ensure that claims are handled in a timely and accurate manner. Common duties include reviewing claim forms, verifying information, contacting members and providers to gather additional information, developing recommendations, and forwarding claims to carriers for payment. The Claims Coordinator will also assist with subrogation and the coordination of claims among carriers.
RESPONSIBILITIES
- Review and verify claim submissions for accuracy and completeness.
- Coordinate with members, insurance adjusters, and other stakeholders to gather necessary documentation and information.
- Verify coverage, calculate benefit payments, and communicate findings to members and providers.
- Maintain the claims filing system with detailed records of claims and related correspondence. Date stamp all received documents, sort and process all claims and other mail, faxes, and e-mails received.
- Ensure the member receives the needed care/services expeditiously and professionally. Provide guidance through the claims process. Assist in resolving any discrepancies or issues that arise during the claims process.
- Prepare a recommendation (pay/don’t pay) on each claim and forward all processed claims to the appropriate carrier.
- Pursue subrogation claims or other potential reimbursement from third-party carriers.
- Support DAN medical services and third-party assistance companies with emergent cases and in other situation where a liaison is needed between DAN medical services and DAN claims.
- Participate in a rotating on-call schedule (emergency 24-hour benefit verification).
- Perform any other duties as directed by the Vice President, Claims and Assistance Services.
MINIMUM QUALIFICATIONS
- Bachelor’s degree or 5 years’ experience in claims customer service or a related field.
- Familiarity with claims management software and other relevant computer applications and MS Office® software.
- Excellent telephone etiquette and communication skills.
- Self-motivated with time management and problem-solving skills and strong attention to detail.
- Ability to handle sensitive information with confidentiality and professionalism.
- Insurance licensing may be required (training and related costs are to be provided by DSI).
Salary : $5,500 - $45,000
