What are the responsibilities and job description for the Claims Management Examiner position at Oncourse Home Solutions?
Who We are
Oncourse Home Solutions (OHS) is a people-centric organization that is owned by private equity firm, Apax Partners operating under the brands American Water Resources, Pivotal Home Solutions and American Home Solutions. We do what is right for our people so they can do their best when serving our 1.4 million customers across the U.S. Our mission is to help homeowners navigate the unexpected, reduce costs, and make homeownership enjoyable for all. Our vision is to make our products and services accessible to all by becoming the most forward-thinking and community-driven home solutions organization of the 21st century. We are committed to fostering an environment that embraces diversity in all forms, where our employees, customers and partners feel valued, respected, and supported.
We partner with cities, utilities, insurance providers, retailers, financial service companies and member associations to help them maintain and protect their customers’ most important asset—their home. Our passion for empowering customers to confidently run their households is what drives us. When our customers need help with home maintenance, repair, or coverage, OHS is there. This is what it means to be an ‘Oncourse Super’—Successful, United, Progressive, Empathetic, Reliable. Supers get it done. We sweat homeownership so our customers don’t have to. We view every day as an opportunity to step up, step out, and remind others that they’re in this together, to stay on course.
We are proud equal opportunity employer, and our employment decisions are based on business needs, job requirements and individual qualifications without regard to race, color, religion, age, sex (including pregnancy), sexual orientation, gender identity, national origin, ancestry, marital status, parental status, mental or physical disability, military or veteran status, or any other basis protected by federal, state, or local law. OHS is committed to recruiting and retaining talented applicants and to providing all employees with a workplace free from discrimination and/or harassment.
Oncourse Home Solutions (OHS) is a people-centric organization that is owned by private equity firm, Apax Partners operating under the brands American Water Resources, Pivotal Home Solutions and American Home Solutions. We do what is right for our people so they can do their best when serving our 1.4 million customers across the U.S. Our mission is to help homeowners navigate the unexpected, reduce costs, and make homeownership enjoyable for all. Our vision is to make our products and services accessible to all by becoming the most forward-thinking and community-driven home solutions organization of the 21st century. We are committed to fostering an environment that embraces diversity in all forms, where our employees, customers and partners feel valued, respected, and supported.
We partner with cities, utilities, insurance providers, retailers, financial service companies and member associations to help them maintain and protect their customers’ most important asset—their home. Our passion for empowering customers to confidently run their households is what drives us. When our customers need help with home maintenance, repair, or coverage, OHS is there. This is what it means to be an ‘Oncourse Super’—Successful, United, Progressive, Empathetic, Reliable. Supers get it done. We sweat homeownership so our customers don’t have to. We view every day as an opportunity to step up, step out, and remind others that they’re in this together, to stay on course.
We are proud equal opportunity employer, and our employment decisions are based on business needs, job requirements and individual qualifications without regard to race, color, religion, age, sex (including pregnancy), sexual orientation, gender identity, national origin, ancestry, marital status, parental status, mental or physical disability, military or veteran status, or any other basis protected by federal, state, or local law. OHS is committed to recruiting and retaining talented applicants and to providing all employees with a workplace free from discrimination and/or harassment.
Position Summary
Reporting to the Claims Management Supervisor, this position is responsible for conducting thorough reviews, investigations, and evaluations to determine the eligibility of claims. You will also be responsible for negotiating claim resolutions in accordance with company policies and state regulatory requirements. As a Claims Management Specialist, you will handle a high volume of claims, maintaining a high standard of adjudication. This includes ensuring timely and accurate payments to both our service provider network and customers. You will actively contribute to process efficiency improvements by assisting with system enhancements for our claims management system, thereby supporting our company's growth objectives. Moreover, this position holds the responsibility of ensuring the accurate and timely processing of all Cost of Goods (COGS) for financial accounting purposes. You will work closely with leadership to provide accurate data for month-end reporting and analysis. The candidate must demonstrate a self-starter attitude with a strong work ethic and exceptional organizational skills.
If you are detail-oriented, possess strong negotiation skills, and thrive in a fast-paced environment, we encourage you to apply for this exciting opportunity as a Claims Management Examiner.
Located at our office in Naperville, IL our office environment is a key driver of our company culture and employee experience, so a regular in-office hybrid model (generally T-TH in office and M & F remote) is required.
Responsibilities include but not limited to:
- Ensure customers and providers are paid timely and accurately within the terms and conditions of programs following best practices while ensuring compliance with state regulatory requirements.
- Ability to communicate effectively with internal and external customers and keep challenging situations from escalating.
- Responsible for handling incoming customer reimbursements requests from start to finish.
- Validate daily NHS wire payment and exceptions.
- Manage the reconciliation of Customer Preferred Pricing transactions.
- Assist with inquiries regarding claim status and general product information with internal and external customers.
- Analyze and validate a high level of claims data and entry into propriety operating system daily including daily audit and reconciliation of data and files.
- Proactively address providers and team on provider non-adherence to contract coverage and terms.
- Develop and build effective relationships within the department as well as with other departments including the contractors in our service provider network.
We’re Excited if This is You
- Minimum of 1-3 years of proven employee management with focus on customer service, invoice processing or similar field.
- 1-3 years’ experience in Accounting, A/P, Billing, A/R, or Claims.
Education
High School Diploma required. Bachelor’s degree in marketing, finance, business, or related discipline preferred.
Competencies
- Customer Focus- Is dedicated to meeting the expectations and requirements of internal and external customers; gets firsthand customer information and uses it for improvements in products and services; acts with customers in mind; establishes and maintains effective relationships with customers and gains their trust and respect.
- Managing Diversity- Manages all kinds and classes of people equitably; deals effectively with all races, nationalities, cultures, disabilities, ages and gender; hires variety and diversity without regard to class; supports equal and fair treatment and opportunity for all.
- Drive for Results- Can be counted on to exceed goals successfully; is constantly and consistently one of the top performers; very bottom-line oriented; steadfastly pushes self and others for results.
- Timely Decision Making- Makes decisions in a timely manner, sometimes with incomplete information and under tight deadlines and pressure; able to make a quick decision.
- Ethics and Values- Adheres to an appropriate (for the setting) and effective set of core values and beliefs during both good and bad times; acts in line with those values; rewards the right values and disapproves of others; practices what he/she preaches.
- Functional or Technical Skills- Has the functional and technical knowledge and skills to do the job at a high level of accomplishment.
- Integrity and Trust- Is widely trusted; is seen as a direct, truthful individual; can present the unvarnished truth in an appropriate and helpful manner; keeps confidences; admits mistakes; doesn't misrepresent him/herself for personal gain.
Computer Skills Needed to Perform this Job
- Proficiency in Microsoft and Google Suites