Overview

The Claim Representative plays a key role in supporting the TPA Services by assisting with the coordination of communication between clients, claim examiner, re-insurers and the captive. He or she timely responds to questions asked by clients and internal teams, advising clients on reporting techniques and procedures, and managing claims through conclusion. Additionally, the Claim Representative supports the team’s TPA Services through the resolution of claims.

Responsibilities

CLAIMS

• Processes claim information from the client, makes appropriate policy verification and inputs claim information into the system
• Instructs insured on gathering proper claim information needed for claim reporting and inputs claims into the system
• Sets diaries to follow claim progress as needed, assigning to other team members appropriately
• Updates RMIS system claim notes, open/closure notices and monitors and maintains electronic filing systems
• Maintains a concern for timeliness and completeness when interacting with customers, agency teams and TPA staff to minimize potential for error and omission claims
• Communicates claims concerns, large claims or potential problems to appropriate Claims Representative or Claims Manager
• Completes Escrow funding requests, submits to reinsurer, ensuring funding is released so payments can be issued
• Oversees Medicare reporting and ensures any concerns are addressed
• Completes status reports on individual claims and prepares for presentation to client
• Assists in developing, training and updating of internal claim procedures, programs and processing
• Addresses and resolves client claim questions/problems
• Identifies PCEs (potentially compensable events) and escalates to Claims Examiner as appropriate
• Owns reporting compliance with state and other professional requirements
• Understands and follows TPA Services procedures

EXECUTION OF CLIENT SERVICE

• Supports Claims Examiner and other internal department members to flawlessly execute Assurance TPA Service’s strategy for each client, designed to create measurable value and efficiencies in their businesses
• Processes changes, as needed or requested by the client, checking for consistency and documenting in the appropriate system
• Builds personalized client relationships through demonstrated understanding of the service plan and multiple channels of communication such as phone, email and in-person meetings
• Leverages insurance knowledge and communication skills to explain coverage terms and claims strategy
• Works with internal departments to ensure cohesiveness and timeliness of service execution
• Manages time effectively to prioritize workload, client service requests and service parameters on business processes

DATA AND PROCESS INTEGRITY

• Maintains accurate and complete claim data in RMIS systems including policy detail, activities, attachments or anything in regard to claims
• Consistently achieves data integrity and meets activity timeliness, quality metrics and goals
• Follows processes and procedures in servicing workflow, maintaining appropriate and clear documentation of client and vendor conversations, taking appropriate action and following up as requested
• Completion of monthly reports; to include Loss Runs, Aggregate Reports and any specific reports as requested by client or claim examiner
• Completed reconciliation of claims payments at frequency requested by auditors or clients
• Utilizes internal resources for identified processes to ensure efficiency and consistency in execution

PEER RELATIONSHIPS

• Provides feedback and shares information at team meetings
• Participates in ongoing scheduled meetings with Claims Team to discuss accounts, renewals, service needs, service platform, etc.
• Develops successful and effective working relationships with Producers, Account Executives, Account Managers, service team members, managers, carriers and members of other departments
• Communicates effectively with Claims Team members and provides timely and complete information to allow them to effectively manage service execution

Qualifications

REQUIRED:

• Knowledge of software systems, to include excel

PREFERRED:

• 1 years of claims handling experience
• BS/BA in Business, Insurance or related field
• Intermediate skill level in Microsoft Office Suite
• Adjuster licensing

About AssuranceAssurance, a Marsh & McLennan Agency LLC, company, is a full-service brokerage providing business insurance, employee benefits, private client insurance, and retirement services to businesses and individuals across the country. Assurance operates as Marsh & McLennan Agency’s Midwest regional headquarters. Consistently recognized as a top workplace, Assurance attracts and retains its insurance talent by rewarding expertise and investing in career development. Assurance employees enjoy an award-winning culture that fosters a highly productive and results-driven working environment.

Services: Business Insurance, Employee Benefits, Financial Services, Private Insurance, SuretyAwards: Assurance is continually named a "Best Place to Work" by leading publications and organizations such as Fortune magazine, the National Association for Business Resources, The Chicago Tribune, Crain's Chicago Business and Business Insurance magazine (check out all of our accolades).Culture: Our employees enjoy an environment that fosters success and creativity and provides countless opportunities for growth. We make sure our employees are happy and motivated by offering enviable benefits, rewards programs, celebrations, perks and a few surprises around every corner. Together, it all adds up to a company that develops and retains passionate individuals who deliver superior performance and measurable results to our clients.

Fun Fact: 31% of Assurance experts agree the best Saturday Night Live skit of all time is "More Cowbell".

Assurance has won over a hundred workplace awards largely due to our intentional and caring approach that begins with meeting our people where they are, celebrating their differences and creating an inclusive environment.

Assurance is a proud equal opportunity employer. We celebrate diversity and we are committed to equal employment opportunities regardless of age, race, ethnicity, color, religion, creed, sex, sexual orientation, gender identity, gender expression, national origin, marital status or civil partnership/union status, veteran status, citizenship, pregnancy, genetic information, physical or mental disability, or any other status or characteristic protected by federal, state or local law.

Harassment or discrimination based upon any of the above is inconsistent with our values and will not be tolerated; this includes harassment or discrimination for being associated with or knowing someone that identifies with any of the above.

Marsh & McLennan Agency (MMA) provides colleagues the freedom to make a career and difference. We encourage you to explore your curiosity and creativity. We gain new insight from diverse thinking, and take risks on new ideas. We embrace a culture that celebrates and promotes the many backgrounds, heritages and perspectives of our colleagues and clients. We are always seeking those with ethics, talent, and ambition who are interested in joining our client-focused teams. More than just insurance brokers, we believe that a business culture that supports a healthy, safe work environment does so by offering the right benefits, programs, policies and opportunities to keep employees engaged and productive including: health and welfare, tuition assistance, 401K, employee assistance program, volunteer opportunities, and other programs.