General Descriptions:

Responsible for timely resolution and payment of claims for clients of the business including but not limited to claim set-up, billing review and payment processing, managing checking account and monthly financial control reporting to carriers.

Responsibilities:

May analyzes coverage, researches claim data and produces loss run reports. Communicates, coordinates and monitors information with insured and carrier adjuster for timely resolution.  Conducts claim reviews with auditors, adjusters, and insurance partners. Responsible for claim advocacy and negotiation, including claim denial review, reservation of rights review, and claim reporting. Analyzes claims based on a best practice outline and partners with other members of the technical resource team. Communicate with stakeholders at various levels within the internal or external organization. Ability to use carrier / TPA claims management systems to generate reports that provide loss information and some level of trends / analytics. Higher-level technical administrative ability with use of Microsoft Suite, ability to produce user friendly documents through internal resources. Determine billing and collection of all self-insured retention and deductibles based on contracts.

·        Handles file set-up and maintenance in addition to administrative and clerical support duties.

Maintain checking accounts for the insurance companies’ settlement accounts Generate and issues monthly financial reports to carrier partners. Perform other job duties as assigned and participate in special projects as required.

Knowledge, Skills and Abilities:

3+ years of claims administration experience. High school diploma or graduate equivalent degree required.

·        Knowledge and understanding of insurance coverage and policies 

Proficient in MS Office suite of products.

·        Ability to navigate multiple computer systems, applications, and utilize search tools to find information 

·        Excellent verbal, written, and interpersonal communication skills 

·        Effective organizational, multi-tasking, and prioritizing skills 

Ability to work well in a team environment. Must have strong analytical thinking and problem-solving skills.