National Account Claims- Senior Associate
- Career Level
- Not Specified
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This area provides a single source of service for Claims and Customer Service for the National Account Customers. This Unit monitors phones, quality of claims/calls and turn-around time in order to meet and/or exceed service levels provided by the contracts with the large cases.
This position is responsible for analyzing and adjudicating claims in accordance with policy provisions with minimal guidance from the medical team or leadership team. A claims examiner must have the ability to interpret and apply laws, rules and regulations as well as evaluate claims from initial report to final determination. They must also be able to obtain and utilize sensitive information discreetly and objectively in addition to documenting claim files with notes, evaluations and decision making processes while achieving optimal customer service.
- A Sr. Associate is responsible for analyzing, processing, researching, adjusting and adjudicating claims which will result in a payment or non-payment of a claim with minimal guidance from the medical team or leadership team.
- Sr. Associates review insurance policies, the claim form and supporting documentation to make sure that all of the information is correct. They determine whether the claims are covered under the policies issued to that policyholder.
- Sr. Associates assist in identifying, investigating and reporting fraudulent claim activity to our internal fraud unit.
- Sr. Associates are required to provide the insured with correspondence that is clear, concise and meets state regulations in relation to the decision they made on the claim processed.
- Previous Claims processing experience preferred.
- Ability to work in a fast paced/deadline driven environment.
- Ability to work independently or in a team oriented environment.
- Ability to interpret and apply laws, rules and regulations.
- Basic policy coverage and insurance regulation knowledge
- Verbal/written telephone communication skills
- Attend training sessions as a participant
- Basic individual claim authorization
- Ability to prioritize and handle multiple tasks
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As a Fortune 100 company and industry leader, we provide a competitive salary – but that's just the beginning. Our Total Rewards package also offers benefits like tuition assistance, medical and dental insurance, as well as a robust pension and 401(k). Plus, you'll have access to a wide variety of programs to help you balance your work and personal life -- including a generous paid time off policy.
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Allstate generally does not sponsor individuals for employment-based visas for this position.
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