Group Claims Support Specialist

Group Claims Support Specialist is responsible for assisting Group Claims Examiners by gathering, verifying, and entering claim information into the claims management system. 

Responsibilities:

• Responsible for the review and management of claims across all lines of Group Insurance, including but not limited to: Short Term Disability, Long Term Disability, Waiver of Premium, and Life claims.
• Review, analyze, and process group claims in accordance with company policies and procedures, ensuring all claims are processed in compliance with regulatory requirements.
• Accurately enter claims data into the claims management system.
• Gather and verify necessary documentation and information from clients and internal departments.
• Maintain comprehensive and organized claim files.
• Provide prompt and courteous service by addressing client inquiries and concerns.
• Communicate effectively with clients, policyholders, and beneficiaries.
• Conduct thorough review to verify claim validity.
• Identify and report potential fraudulent claims.
• Stay current on changes in industry regulations and standards.
• Work closely with other departments, such as underwriting, legal, and compliance teams, to resolve complex claims.
• Coordinate with external parties, such as medical professionals and service providers, as needed.
• Analyze claims data to identify trends and patterns.
• Prepare reports and summaries for management review.
• Utilize claims management software and other tools to streamline claim processing.
• Address and resolve any discrepancies or issues that arise during the claims process.
• Develop and implement solutions to improve claim handling efficiency.
• Build and maintain strong relationships with key clients and stakeholders, ensuring a positive client experience throughout the claims process.
• Prepare and organize claim files, ensuring all necessary documentation is complete and accurately filed.
• Maintain accurate and up-to-date records of all claims-related activities.
• Scan, upload, and manage electronic and physical documents related to claims.
• Generate standard reports and summaries for the claims team and management.
• Respond to basic inquiries from policyholders, beneficiaries, and clients regarding the status of their claims.
• Assist the Group Claims Department with new claims set-up, filing, archiving, and ordering archived claim files, job requests, copying, sending out letters, and participating in special projects as necessary.
• Assist with incoming mail review through regular USPS or electronic mail from Data Dimensions. Evaluate disability applications for thoroughness; request additional documentation from the applicant or employer, as necessary. Route electronic mail to the designated Claim Specialists.
• Index different document types that come into the Group Claims Department by mail, electronic mail, faxes, and email. Set up initial disability claim records in our paperless claims storage system.
• Set up invoices for payment of expenses from vendors and medical providers.
• Review Paid Up Life applications and enter the new applications in Microsoft Access.
• Update PolicyPro to reflect Employer and Contact person changes.
• Process and mail FICA billings, commission checks, and other reports monthly.

 Requirements:

• High School diploma or GED required
• Bachelor’s degree in a related field or equivalent work experience
• Experience in an administrative or support role within the insurance or financial services industry preferred.
• Strong organizational and time management skills.
• Excellent attention to detail and accuracy.
• Effective communication and interpersonal abilities.
• Basic knowledge in Microsoft Office Suite and familiarity with claims management software preferred.

Pay Range:

• $18.51 - $29.13/hr.

Salary is commensurate to experience, location, etc.

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