• Receive new claims intake information.
• Set up new files in claim system.
• Organize documents in claim file repository.
• Reformat and organize claim data reports.
• Schedule claims meetings, including organizing and transmitting documents to meeting participants.
• Receive and resolve incoming claim related inquiries.
• Assist Finance department in resolving claim payment transaction inquiries.
• Support scheduling and data transfer relating to reinsurance audits.
• Receive and process letters for mailing.
• Electronically file insurance documents via SERFF system.
• Prepare and send file closure documents to state (DOBI and BME) and national (NPDB) agencies.
• Enter data to support system file closure process.

• Discuss relevant claim with member physician.
• Receive and review relevant pleadings, medical records, and other investigative documents.
• Interview physician members with claims to determine liability, causation, and damages as applicable to each claim.
• Review and evaluate insurance contract wording and coverage for each claim.
• Discuss claim with appointed panel counsel and establish a comprehensive investigative and litigation management strategy for each claim.
• Manage claims within preexisting litigation protocols and practices.
• Recommend reserves and investigative strategies.
• Enforce litigation guidelines and strategies as cases require.
• Conduct limited legal and other research on medical/legal issues that affect the Department or Company.
• Adhere to the Conventus Claims Guidelines document as it relates to claims handling.
• Assist in statistical reporting and generate claims and loss reports, as required.
• Attend Claims Committee meetings, as assigned, and assist in preparing Committee reports and documents, as warranted.

3. General:

• Act as a resource and consultant to other departmental personnel for claim and other risk exposure issues.
• Assist in development and publication of newsletters and related claims department materials.
• Collaborate to improve effectiveness, efficiency, and teamwork of claim department.
• Other duties as assigned.

What Were Looking For

• Associate degree and/or Paralegal Certification required.
• Bachelors degree preferred.
• 5-7 years of administrative experience, preferably involving healthcare claims in a corporate or law firm setting.
• Paralegal and/or claim handling experience preferred.
• Strong interpersonal communication and presentation skills.
• Negotiation skills.
• Excellent organization and prioritization skills.
• Sound judgement and problem-solving skills.
• Working knowledge of Microsoft Office (Word, Excel, etc.)

What You'll Receive

At NIP Group, we recognize there are many factors that contribute to your overall satisfaction both at work, and in your personal life. For that reason, we provide a perfect mix of compensation, benefits, company culture, and resources to ensure your everyday happiness. Below are some benefits that youll receive.

• Competitive compensation to reward you for your hard work every day.
• Progressive Paid-Time Off program for you to enjoy time out of the office, including time off for volunteering and life events.
• Group Medical, Dental, Vision and Life insurance to encourage a healthy lifestyle.
• Pretax Health and Dependent Care Spending Accounts to ease taxes on spending.
• Discounts in retail and entertainment.