CLAIMS REPRESENTATIVE

Department : Third Party Administration (TPA)

Reports To : TPA / COBRA Benefits Manager FLSA Status : Non-Exempt

Salary Range : $50,000 - $55,000

Employment Status : Full-Time; Monday-Friday 8 : 30am -5 : 00pm

Position Summary :

The Claims Representative will be responsible for processing insurance claims efficiently and accurately, ensuring timely resolution and customer satisfaction.

This position works closely with clients, policyholders, and internal teams to gather and analyze information, make informed decisions regarding claim validity, and facilitate timely resolutions.

Essential Duties and Responsibilities

• Review and evaluate insurance claims submitted by clients ensuring completeness and accuracy of documentation.
• Conduct audits into claims, including gathering relevant information from clients and policyholders.
• Maintain detailed records of claims processing activities, including correspondence, reports, and claim status updates.
• Communicate effectively and professionally with clients, policyholders, and internal teams to provide updates on claim status, resolve issues, and address inquiries.
• Key HRA and FSA claim data accurately.
• Ensure compliance with industry regulations and company policies in claims processing and documentation.
• Work towards prompt and fair resolution of claims, negotiating settlements when necessary and escalating complex issues to management as needed.
• Provide exceptional customer service throughout the claims process.
• Identify opportunities for process improvements in claims handling, suggesting, and implementing solutions to enhance efficiency and quality.
• Perform other work-related duties as assigned.

Minimum Qualifications

• Bachelor's degree in Business Administration, Insurance, or related field preferred.
• Previous experience in claims processing or insurance administration is highly desirable.
• Strong analytical skills with attention to detail.
• Excellent communication and interpersonal skills.
• Proficiency in using claims management software and Microsoft Office Suite.
• Knowledge of insurance policies, regulations, and industry best practices.

Note : New York State Licensing in Life, Accident & Health (LAH) will be required within the first three months of employment.

Physical Demands and Work Conditions :

The physical demands described here are representative of those that should be met by an employee to successfully perform the essential functions of this job with or without reasonable accommodation.

While performing the duties of this position, the employee is frequently required to sit, walk, bend, use hands (i.e. : type, write), talk, and hear.

The employee is occasionally required to stand and walk. Employee may occasionally be required to lift and / or move up to 15 pounds.

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

The noise level in the work environment is usually low to moderate.

Nothing in this document should be interpreted as an offer of employment and all employment with Bene-Care and its affiliates is at will.

Reasonable accommodation will be made as determined by the interactive process upon request and job duties may be adjusted as needed to ensure that any current or potential employee is successful at Bene-Care.

Bene-Care and its affiliates are Equal Opportunity Employers.

Last updated : 2024-05-18