Job description

Summary

The Claims Assistant shall be responsible for a variety of support functions for Claims Operations, which includes, but is not limited to, handling the intake of Aggregate Accommodation Requests/Claim Submissions, updating the claim systems related to the receipt of high-dollar claim notifications and monthly reports received from Third Party Administrators ("TPAs") and/or Policyholders, preparing Aggregate Claim files for the Claims Staff, assisting with the Aggregate Claim Reconciliation Process when Stop Loss Policies are completed by pursuing the needed documentation from the TPAs/Policyholders, and performing other assorted tasks/responsibilities, as assigned.

Essential Duties And Responsibilities

Perform Claim Intake Process, which includes, but is not limited to:

Creating a new claim folder in our shared file system.
Uploading the claim documentation into the new claim folder.
Setting up a new claim record in the claims system.
Cross reference any duplicate filings and coordinate with the Claim Specialists in relation to closing the previous filing.

Retrieve all Monthly Aggregate Reports from the TPAs and input them into the system.
Add all High-Dollar Trigger Notifications into the applicable shared file and claims system, and then consult with Claims Management to determine if further action is needed.
Add Plan Documents ("PDs"), Summary Plan Descriptions ("SPDs"), and Stop Loss Policies into the corresponding claim folders, as well as send requests to Account Executives to pursue missing PDs/SPDs.
As needed, follow up with TPAs and Policyholders to check status of requests for information and documentation in pended claim scenarios.
Assist with the Aggregate Claim Reconciliation Process, by pursuing needed information/documentation.
Support Claims Team when directed by Claims Management (i.e., other duties, as assigned).

Qualifications For The Claims Assistant Include

Requires a high school diploma or equivalent. Bachelor's Degree is a plus.
Claims and/or data entry experience preferred.
Strong analytical abilities, excellent verbal and written communication skills, sound organizational capabilities, and effective customer service skills are a must.
Highly proficient in Microsoft Office applications, especially Outlook, Excel, and Word.
Must have the ability to work effectively on a team, as well as work well independently.
Must be able to work in a fast-paced environment and maintain acceptable productivity, while maintaining a high level of quality.

Salary: $47000 per year

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