Claim Operations Coordinator

Claim Operations Coordinator

BASIC PURPOSE: Perform claim related administrative duties throughout the claim's life cycle for all lines of business in multiple claims systems. Provide quality claim service within state requirements and corporate claim standards. Duties my include, but are not limited to, intake of claims, claim financial transactions, claim data collection and entry, and various claim compliance tasks.

PRIMARY JOB RESPONSIBILITIES:

• Triage and assign claims to Adjusters following the Line of Business segmentation guidelines and assignment rules.
• Enter and confirm payments made are in line with the contracted services. Identify and escalate when invoicing is unusual or off budget.
• Act as a subject matter expert to develop operational and compliance related procedures, standard work, and processes as requested.
• Timely and accurately investigate, distribute and process misdirected electronic information and mail received from internal and external sources to the appropriate unit, individual, or company.
• Monitor electronic queues and shared inboxes to ensure work is being performed within service levels and according to quality guidelines. Electronic queues may include those used with TPA (third-party administrators) integrations and payments.
• Issue authorized and approved expense and loss payments in the claim system as instructed and document the electronic file as necessary ensuring payments are coded accurately.
• Assist in the maintenance of multiple applications, systems, and portals to support the Claim Department.
• Perform compliance related tasks as assigned to support compliance research, initiatives or the development of compliance job aids and guidelines.
• Complete general administrative tasks and other work duties as assigned.

QUALIFICATIONS:

• High School diploma or equivalent is required. Office, clerical, computer and/or insurance classes are desirable.
• Prior work experience in an Insurance, Customer service or office environment is preferred.
• Proficient data entry skills.
• Ability to process work using Microsoft Word and Excel.
• Must be self-motivated.
• Possess a cooperative positive attitude.
• Ability and willingness to answer phone calls from internal/external customers and deliver the required level of service and support.
• Must use time management skills to manage work independently following established processes and guidelines.
• Must be able to collaborate as part of a team.

WORK ENVIRONMENT:

NOTE: This job description in no way states or implies that these are the only duties performed by this employee. Employees may be requested to perform job‑related tasks other than those specifically presented in this job description. The employer reserves the right to change or assign other duties to this position.