What are the responsibilities and job description for the Claims Coordinator position at illumifin?
The nation's leading administrator of insurance services is looking for YOU. This is your opportunity to join a company with a culture that promotes respect for people, integrity, learning and initiative.
WE ARE THE KIND OF EMPLOYER YOU DESERVE.
Illumifin is a leading provider of business process outsourcing for the insurance industry, managing policies for the nation's largest insurers. We also provide clients with unique risk management insight built upon our proprietary databases.
WE ARE THE KIND OF EMPLOYER YOU DESERVE.
Illumifin is a leading provider of business process outsourcing for the insurance industry, managing policies for the nation's largest insurers. We also provide clients with unique risk management insight built upon our proprietary databases.
- Review internal databases, client guidelines and policy contract language to evaluate routine home and facility-based claims, in accordance with department processes and standards.
- Communicate clearly and routinely with claimants, representatives, third parties, physicians and other healthcare providers as needed. Additionally, effectively communicate with other team members and leadership on cases, as needed.
- Query service providers to obtain licensure information, proof of loss and dates of service. Verifies that provider and/or care is appropriate base on the claimant’s diagnosis and is in accordance with contract language and government regulations regarding healthcare providers.
- Maintain clear and concise documentation of all claim activity within the required databases.
- Create plans of care and refers for review and Chronic Illness Certification as appropriate.
- Always provides prompt, courteous and excellent customer service to internal and external customers.
- Demonstrate effective communication skills, level of attentiveness and use of appropriate lines of authority. Promptly shares accurate and complete information to others who need it, based on HIPAA and legal documents regarding release.
- Perform work accurately and demonstrate ability to prioritize workload.
- Attend or is responsible for information provided at meetings and through other organizational channels.
- Uphold the principles of compliance as outlined in the Code of Conduct, Employee Handbook and related policies and procedures. Supports and participates in the mandatory Corporate Compliance Program training initiative on an annual or more frequent basis, as required.
- Meet established quality and production expectations as established and communicated by the department.
- Work independently with minimal direction.
- Other duties as assigned.
