SUMMARY: The primary focus of this position is to provide support to the Claim and Operations Team. This includes but is not limited to returning phone calls, printing and depositing of checks, creating notes in system, closing claim files, and assisting in preparation of file reviews as well as other miscellaneous support activities. Computes medical bills associated with accidents and ensures timely payment.
RESPONSIBILITIES/TASKS:
Supports the customer service work and processes for the multi-functional Claims and Operations teams including check printing, bank deposits, mail management.
Answers general claim inquiries from providers and provide verification of claim status.
Communicates and collaborates with team members to ensure the appropriate and timely handling of claims. Supports the team as required.
Supports the account management process appropriately for the team's book of business.
Computes the proper payment for the medical bills for non-indemnity and simple indemnity claims directly associated with the accident or activity. Computation is based on knowledge of the treatment given the individual and its relationship to the injury to relieve and/or cure the injury sustained as well as workers’ compensation provisions in the state the employer is domiciled.
Provides administrative support to the Claims Department using word processing and spreadsheet applications. (Lien letters, timelines for medical treatment/events, etc.)
Ensures that all payments are made in an accurate and timely manner and that all files are closed to meet internal performance standards while complying with state legislation to avoid penalties and reduce the amount of supplemental bills.
Adheres to the Employee Code of Ethical Conduct.
Completes other duties and special projects as requested
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
EMPLOYMENT QUALIFICATIONS:
EDUCATION OR EQUIVALENT EXPERIENCE:
High school diploma or G.E.D required. College coursework in English, Mathematics, Business Administration or Administrative Management OR the equivalent in insurance-related course work and experience is required. At least 2 years of administrative experience. Continuous learning required, as defined by the Company’s learning philosophy. Certification, or progress toward, highly preferred and encouraged.
EXPERIENCE:
Previous experience in an insurance environment or previous knowledge of workers' compensation laws is desired. Knowledge of medical terminology is preferred.
SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:
Ability to work independently as well as in a multifunctional business unit is essential.
- Effective oral and written communication skills are essential.
- Excellent customer service and organizational skills are essential.
- Ability to manage multiple priorities and adapt to changing workflow in order to still meet deadlines and goals are essential.
- Proficient in Microsoft Windows
- Attention to detail and analytical skills required.
- Ability to enter and verify alpha/numeric data accurately.
WORKING CONDITIONS:
Work is performed in an office setting with no unusual hazards. Applicants must be available to work four days in the Office.
PAY RANGE:
Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $39,100 and $65,600.
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description.
We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis. Nothing herein is intended to create a contract.
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Skills Required
- High school diploma or GED
- College coursework in English, mathematics, business administration, or administrative management, or equivalent insurance-related coursework and experience
- At least two years of administrative experience
- Ability to work independently and in a multifunctional business unit
- Effective oral and written communication skills
- Excellent customer service and organizational skills
- Ability to manage multiple priorities, adapt to changing workflow, and meet deadlines and goals
- Proficiency in Microsoft Windows
- Attention to detail and analytical skills
- Ability to enter and verify alphanumeric data accurately
- Previous experience in an insurance environment or knowledge of workers’ compensation laws
- Knowledge of medical terminology
- Certification or progress toward certification
What We Do
Emergent Holdings’ elite team makes lives, companies and communities better! Emergent Holdings is driven by a singular goal — improving the health and safety of our customers and our communities. How do we do that? We create innovative insurance products, technology solutions and services to support our key stakeholders — individuals, employers, providers and strategic partners — improving the health and safety of the people and places we serve. At Emergent Holdings, we’re inspired to create, to challenge the status quo, to think not just about what our customers need now, but what they will need in the future. We are strategic thinkers. We are industry innovators. We are market trendsetters. Together, we are Emergent Holdings. Our diverse team of established industry experts embraces a culture of innovation and entrepreneurial spirit. That means we’re focused on innovation, on leading and shaping our markets and improving health and safety for our customers and communities. For our customers, the result is a suite of solutions, services and products delivered ahead of market needs — and in anticipation of member demands. We are tireless in our pursuit of the exceptional, and our companies deliver optimal customer experiences and improve people’s lives every day, by making workplaces safer and delivering affordable, solutions-focused healthcare services.
