ABOUT INSURANCE ADMINISTRATIVE SOLUTIONS

Insurance Administrative Solutions (IAS) is a third-party provider of comprehensive administrative solutions for our clients in the insurance industry. We offer a business process outsourcing solution that helps insurers optimize administrative workload, bolster their industry expertise, leverage emerging technologies, and streamline operations. With strong industry knowledge, we deliver value to our customers by providing compassionate customer service, efficient processing, and quality results. Here at IAS, we embrace the fact that great things are only accomplished by working as a team. We believe that all of our employees have valuable input no matter the level. Our highly collaborative team environment offers each of our employees a place where they can excel.

JOB SUMMARY: Responsible for the assistance with various clerical duties in support of the claims staff. Provide prompt and courteous customer service. Utilize applicable policy form, insurance law and internal procedures to answer inquires and process requests for clients and department. Analyze claims to determine the extent of insurance carrier liability. Interpret contract benefits in accordance with specific claims processing guidelines. Clear understanding of how various functions with the operation relate to and impact each other.

Candidate must be local. This is not a remote position, at this time.

ESSENTIAL DUTIES & RESPONSIBILITIES: (Other duties may be assigned as necessary.):

• Communicate effectively and professionally with providers, agents, policyholders and their representatives.
• Filing. Retrieving case files and updating/placing corresponding documents in appropriate case files.
• Prepare and copy documentation and /or files for mailing to clients.
• Assist with daily file transfer between departments.
• Send out monthly-standardized letters.
• Maintain the daily distribution of the mail and fax logs.
• Sort and distribute incoming mail.
• Provide training and or direction to new employee as applicable.
• Maintain billing log for vendors, and recognizing applicable deadlines for completion.
• Process ongoing case load and make decisions necessary to properly adjudicate those claims and written inquiries.
• Interpret contract benefits in accordance with specific claim processing guidelines.
• Understand broad strategic concept of our business and link these to the day-to-day business functions of claim processing.
• Communicate effectively and professionally with providers, agents, policyholders and their representatives, and vendors.
• Interact and communicate professionally with manager, supervisor, and other departments.
• Maintain individual caseloads and internal reports for claim tracking purposes.

OTHER FUNCTIONS:

• Coordinate tasks and schedules with team members for maximum team efficiency.
• Review, utilize and maintain procedure manuals.
• As needed miscellaneous duties/ projects as assigned by management.

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

• Team centered with excellent work ethic and reliability required.
• Must possess excellent verbal and written communication skills.
• Ability to work independently and exhibit flexibility in performing multiple functions.
• Ability to operate office equipment.
• Good PC application skills a plus.
• Excellent telephone and customer service skills.
• Good attendance and work ethic.
• Must have excellent organizational and decision making skills
• Medical terminology and previous health/Medicare/Rx/Disability claims experience a plus.
• Ability to calculate figures accurately.
• Clear understanding of the policy benefits and procedures with in the Claim unit.
• Must be able to manage time effectively with written correspondence, faxes, and referrals from other departments in order to comply with service guarantees.

EDUCATION and/or EXPERIENCE REQUIRED:

• High School Diploma or GED equivalent.
• Prior claims processing, customer service, and clerical experience is preferred.
• Medical terminology and previous Long Term Care Claim processing experience is a plus.
• Insurance, PC, Windows, Word and Excel experience is required.

Benefits:

• Medical/Dental/Vision Benefits first of the month after hire date
• 401(k) Company matching and contributions are immediately vested
• 15 days PTO after 90 days
• Referral program
• 11 Paid Holidays
• Employee Assistance Program
• Tuition Reimbursement

Schedule:

• Monday to Friday
• 37 hour work week

IAS is an equal opportunity employer.