Claims Associate

General Summary

Claims Associates are responsible for processing, vetting, and managing business claims. They collect and review data to determine eligibility, risk, and the applicable legal or regulatory requirements related to each claim.

Essential Job Functions/Responsibilities:

• Verifying the validity of claims.
• Investigating suspected fraudulent claims.
• Negotiating settlements and reimbursements with claimants.
• Preparing and submitting claims documents for payment.
• Ensuring accuracy of all accounts receivable.
• Ensuring compliance with all applicable laws and regulations.
• Maintaining accurate records of all claims.
• Communicating with other departments to ensure timely resolution of claims.
• Developing strategies for efficiently processing and handling claims.

Skills:

• Knowledge of legal and medical terminology.
• Ability to work independently and as part of a team
• Proficiency with Microsoft Office and claims management software
• Strong critical thinking and analytical ability
• Excellent negotiation, conflict resolution and interpersonal skills.
• Ability to remain calm under pressure and work through challenging claims.
• Strong communication skills, both verbal and written.

Qualifications

• Bachelor's degree in a related field
• 3-5 years of experience in property and/or casualty claims handling
• Experience in client satisfaction