What are the responsibilities and job description for the Claims Administrator position at SCP Health?
At SCP Health, what you do matters
As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.
Why you will love working here:
- Strong track record of providing excellent work/life balance.
- Comprehensive benefits package and competitive compensation.
- Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.
Direct and report on the day-to-day activities associated with claims and current litigation by using the most practical, efficient and cost-effective methods available to Claims Administration.What you will be doing:
- Primary contact for receipt of any type of legal communication for review.
- Review and analyze all incoming legal communications and disburse or handle as appropriate.
- Create claim file in electronic format within Origami and oversee the day-to-day electronic filings.
- Ensure correct healthcare provider is named, facility contract was active and gather appropriate supporting documentation to Insurance for vetting of coverage.
- As needed, facilitate review of all claims, quality review issues and patient resolution issues by internal and/or consulting medical experts.
- Assist internal medical expert with calendar and scheduling.
- Make initial contact with healthcare providers to notify them of new claim and counsel them on confidentiality, responses, and verbal discretion. Forward copies of documents received.
- Assist attorneys, litigation management companies and claims managers in obtaining required documentation and providing prompt response to all subpoenas, deposition and discovery requests.
- Receive, review, interpret and respond to all legal correspondence related to claims (provider or patient related) and notify appropriate manager(s) and/or director(s) of case development.
- Update and maintain Origami by documenting all relevant claim-related issues.
- Assist with Origami in claims-related areas of trouble shooting, process assistance, maintenance, reporting and other areas of user needs.
- Assist external and internal Origami users as first resource for claims-related system support, escalating to Risk Analytics division when appropriate.
- Work with Risk Analytics Division to ensure processes, fields and event triggers remain efficient and effective for users as new system builds and user processes evolve.
- Work with litigation management companies and outside counsel in monitoring and tracking litigation guideline reporting.
- Interact with defense attorneys and litigation management companies to provide direction on handling claims as requested.
- Review all bills, fee statements and invoices received from defense attorneys and “scrub” as indicated, providing explanation for fee reductions.
- Coordinate quarterly conference calls with defense counsel.
- Coordinate with RCS Ops to clear deceased patient write-offs.
- Interact with litigation management companies to clarify fees/ bills and request documents or assistance with a claim.
- Work closely with insurance representatives and provide assistance and support as needed.
- Actively participate in all claims meetings.
- Maintain trial, mediation and deposition calendars.
- Assist with actuary data reconciliation.
- Participate in quality review/patient complaint issues, including tracking all issues, requesting records, updating Origami, ensuring each person has reviewed records and file as necessary.
- Ensure defense counsel compliance with Litigation Guidelines.
Who/What we are looking for:
- Bachelor’s Degree or Paralegal Experience (5 years)
- All or one of the following: medical training/degree; insurance claims exposure training/degree; legal training/degree
- All or one of the following: Knowledge and experience in the inner workings of the Emergency Department, medical malpractice/ risk management / claims handling, legal medical malpractice defense or plaintiff or claims management
- Knowledge of medical terminology preferred
- Interactive and effective communication skills with healthcare providers, nurses, attorneys and other professionals
- Ability to set priorities and demonstrate sound judgment
- Strong computer/communication skills, data collection, analysis and reporting skills
This position is eligible for our corporate benefits, please click this link for the details: https://myscpbenefits.com/
SCP Health and its affiliated companies (collectively, “SCP Health”) require applicants for specific positions, such as those onsite at a client company/healthcare facility or affiliate to be vaccinated against COVID-19 as a condition of employment, except where prohibited by state or local law. To demonstrate compliance with SCP Health’s vaccination policy, proof of COVID-19 vaccination status will be requested upon a conditional offer of employment for onsite positions at a client company/healthcare facility. SCP health will consider religious and/or medical/disability accommodation and other legally required exemption request as required by applicable law.
To learn more about SCP Health, please visit:
www.scp-health.com
Join our social circle:
- Check out our LinkedIn Page
- Like us on Facebook
- Follow us on Twitter
SCP Health is an Equal Opportunity Employer
INDJV
#LI-AR1
INDJV
#LI-AR1
To learn more about SCP Health, please visit:
www.scphealth.com
SCP Health is an Equal Opportunity Employer.
