Claims Processing Associate
AF Group

SUMMARY:

This role will focus on maintenance of our incoming workload, issue resolution and first report of injury (FROI) issues. This position determines ownership for entry of first notice of injury (FNOI) from multiple sources across multiple AF Group brands and distributes to the proper destination. This position also supports the enterprise by completing priority and special requests, including, but not limited to, correcting newly created claims.

PRIMARY RESPONSIBILITIES:

• Processes Workers' Compensation claims retrieved from Open Pool queues or via telephone; codes body part, diagnosis, and cause of injury by entering submitted data in the claims system reviews claim for accuracy prior to completion and performs all tasks specified for state-specific requirements after claim setup.
• Confirms policy coverage for date of injury, business location and injury location; requests policy update for locations as needed.
• Identifies jurisdiction, date of injury, special/additional handling items and all pertinent claim related information necessary for claim setup.
• Utilizes all available tools to determine owner of document among all AF Group brands and affiliated business partners and routes appropriately.
• Receives incoming general new claims calls for all entities and serves as a backup for our Assigned Risk Solutions team.
• Makes changes, corrections, and updates on newly created and/or existing claims or submissions as well as guiding end-users on process techniques in various applications.
• May serve as a resource regarding intake-related issues, i.e., determine jurisdiction, assist in clearing policy issues to process claim; in finding coverage or other information.
• May participate in training employees new to the role.
• Maintains department procedures, working instructions and job aides; may participate in creating new workflows or workflow changes.
• Forwards misrouted mail to sender using appropriate form letters.
• Routes documents to medical bill review vendor.

This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION REQUIRED:

High school diploma or G.E.D.

EXPERIENCE REQUIRED:

Customer service experience that provides the required skills, knowledge, and abilities.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:

• Excellent verbal and written communication skills.
• Ability to be an independent thinker to solve issues.
• Excellent organizational skills and ability to prioritize work to meet established deadlines.
• Basic knowledge of computers and spreadsheet software with data entry ability Basic knowledge of word processing software.
• Ability to utilize current and legacy systems, along with other tools, to determine document ownership and distribute appropriately.
• Excellent customer service skills
• Knowledge of multi-functional telephone system.
• Ability to proofread correspondence for accuracy of spelling, grammar, punctuation and format.
• Ability to verify data for accuracy.
• Ability to multi-task i.e. interacts on telephone while entering data.
• Ability to work effectively with various business units.
• Ability to train and coach others to perform the core responsibilities.
• Ability to work varied hours/days/shifts.

ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES PREFERRED:

• Insurance Institute of America (IIA) or other insurance related coursework.
• Knowledge of Workers Compensation or insurance.
• Basic knowledge of spreadsheet software.
• Knowledge of medical terminology.
• Knowledge of claims reporting process for multiple states.
• Experience using a document management system with workflows.
• Other insurance related coursework.
• Experience providing customer service over the phone.
• Excellent telephone etiquette.
• Ability to be able to assist lead worker with CA EAMS searches and pulling of necessary documents.

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. Work may be performed at varied hours/days/shifts.

REQUIRED TESTING:

Basic Word, Basic Excel, Basic Windows, Reading Comprehension, Alphanumeric Data Entry, and Proofreading

This job has expired.