Claim Clerk

Job Description

Job Description

The Claim Clerk is responsible for performing clerical functions in support of the claims units and the department. Receive and direct work and provide functional support service including (but not limited to) handling telephone calls, input of source data, entering or ordering official reports, indexing and routing correspondence, file coding and maintenance, receiving and processing new claims, and making payments to support the achievement of the departments business objectives.

DUTIES & RESPONSIBILITIES

• Receive claim first notice reports via telephone or electronically and enter into systems.
• Provide first point of contact advice and deliver helpful customer service.
• Answer phone calls and assist or refer to correct personnel.
• Direct communications through correct workflows and resolve problems.
• Extract coverage and claims data and enter into appropriate systems or programs.
• Perform claim file setup functions completely, quickly and accurately.
• Ensure that coding is accurate and updated.
• Perform various tasks to assist file handlers and customers.
• Order, distribute and enter various reports as required.
• Index, label and process customer correspondence such as faxes, mail and e-mail.
• Complete recordkeeping in various logs and diary.
• Order, organize and distribute office supplies.
• Process payments and recoveries in the system; audit, add attachments, stuff envelopes and mail paper checks.
• Provide administrative support such as word processing, transcription and spreadsheet data entry for the department.
• May be required to greet and screen visitors to the office.
• Assist colleagues in other units as workload dictates.
• May be required to participate in CAT teams.
• Provide accurate and timely information to all external and internal customers concerning claim status and other claim inquiries consistent with degree of experience.
• Improve processes within the department to increase the level and quality of service provided to internal and external customers, i.e. workflow changes, systems implementation, etc.
• The Claim Clerk is also responsible for performing numerous miscellaneous clerical tasks in support of the unit and department.
• Performs other duties or special projects as required or as assigned.

SUPERVISION RECEIVED

Close supervision is received from the Supervisor or senior staff.

QUALIFICATIONS

PHYSICAL DEMANDS / WORKING CONDITIONS