What are the responsibilities and job description for the Claims Administrator position at Lindamood, Inc.?
Responsibilities
- Claim Intake and Review:
- Receive and review claims submitted by employees, clients, or policyholders.
- Ensure that claims are complete, accurate, and meet the criteria for coverage.
- Verify all necessary documentation is included and initiate follow-up for missing information.
- Claims Processing:
- Process and evaluate claims for approval or denial based on company policies, insurance contracts, or service agreements.
- Review medical, accident, or other relevant information to assess the validity and value of the claim.
- Update and maintain claims records in the system for tracking and auditing purposes.
- Communication with Stakeholders:
- Communicate with claimants (employees, customers, vendors) to inform them of claim status and gather additional information if needed.
- Respond to questions from claimants and other stakeholders regarding claim progress and outcomes.
- Work with insurance carriers, third-party administrators, or legal teams when necessary.
- Investigation and Analysis:
- Investigate the details of complex claims and conduct research to verify the accuracy of the claim.
- Analyze the severity and validity of claims to make determinations on approvals or denials.
- Coordinate with medical professionals, law enforcement, or other specialists as needed for thorough investigation.
- Claims Resolution and Settlement:
- Work to resolve claims efficiently, ensuring all details are correctly documented and payments are processed in a timely manner.
- Negotiate settlements when applicable, ensuring compliance with company policies and legal requirements.
- Process claims payments, track any pending or disputed claims, and follow up on unresolved issues.
- Record Keeping and Documentation:
- Maintain accurate, detailed, and organized records of all claims, correspondence, and settlement activities.
- Prepare reports on claim status, trends, and financial summaries for management and auditing purposes.
- Compliance and Regulations:
- Ensure that claims processing complies with internal policies, industry standards, and regulatory requirements.
- Keep up to date on any legal or regulatory changes related to claims administration.
- Customer Service and Support:
- Provide a high level of customer service by addressing claimant concerns and inquiries in a timely, professional manner.
- Offer guidance on the claims process and ensure a positive experience for claimants.
- Continuous Improvement:
- Recommend improvements to claim processes, systems, or policies based on feedback or identified inefficiencies.
- Participate in training and development opportunities to stay current on best practices and changes in the industry.
- Strong attention to detail and organizational skills.
- Excellent communication skills for interacting with claimants and other stakeholders.
- Knowledge of insurance policies claims processing, and legal regulations.
- Ability to handle confidential and sensitive information with discretion.
- Proficiency with claims management software and tools.
- Problem-solving skills and the ability to make sound decisions.
- Ability to work under pressure and manage multiple claims simultaneously.