What are the responsibilities and job description for the Claims Service Specialist position at ARAG North America?
Purpose
Are you service-minded and detail oriented? Do you understand claims submission and processing? Do you excel at communicating and solving problems?
ARAG is hiring a Claims Service Specialist! This person will examine, research, and process claims within a designated timeframe. The ability to effectively prioritize workload, meet deadlines, and maintain accuracy in a fast-paced environment is required.
Essential Duties and Responsibilities
- Examines, researches and processes claims with proper application of ARAG policies and plan certificate language including:
- Reviewing claims rules results and documenting appropriate response.
- Approving or denying claims based on research conducted.
- Preparing written requests for additional information when needed.
- Processes claims within established performance standards, including turnaround time and Quality Assurance scores.
- Reviews and understands documents pertinent to claims processing including: claim forms, claims history, provider bills, communications from outside parties and various court documents and records.
- Engages in departmental discussions to improve processes and outputs.
- Documents claim records when needed with decision details.
- Serves as a positive role model by representing the ARAG at its Best and Leadership at its Best.
- Other duties as assigned.
Qualifications
Knowledge
- Knowledge of policy provisions as related to review of claims submissions and processing.
- Understanding of common legal matters, their processes and terminology.
- Knowledge of applicable privacy laws.
Skills
- Understanding of department functions as related to claims processing.
- Proficiency in MS Office and Adobe Acrobat Version 8.0 or better.
- Demonstrated ability to operate a variety of software applications in order to process claims.
- Proven attention to detail, including data entry and identification of exceptions to trends.
- Strong communication, analytical and problem solving skills.
Education
- High School diploma or equivalent.
Experience
- 1-3 years of related experience.
Certifications, Licenses, Associations, etc.
- None.
Physical
- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.