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Alpharetta, GA
(Click company name to view employer profile and all available positions.)
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| Career Field |
Claims
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| Insurance Discipline |
All
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| Relocation Assistance |
Not Available
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| Job Duration |
Full Time |
| Salary Offered |
Open
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Purpose:
Investigate, evaluate, reserve, medical manage and resolve 1st party injury claims in accordance with Best Practices. Provide quality claim handling and superior customer service on assigned claims, while engaging in management of payout. Promptly manage claims by completing essential functions including contacts, investigation, damage/injury development, evaluation and reserving. Must be able to work a variable schedule of hours including later shifts and/or weekends.
Responsibilities and Duties:
- Provide voice-to-voice contact within 2 hours of first report.
- Complete timely coverage analysis and communication with insured based on
application of policy information to facts or allegations of each case. Consult with Unit
Manager on use of Claim Coverage Counsel.
- Investigate each 1st party injury claims or first party medical benefits claims through
prompt contact with appropriate parties such as policyholders, accounts, claimants, law
enforcement agencies, witnesses, agents, medical providers and technical experts to
determine the extent of injuries and damages. Support other units as needed, i.e., Set
up appraisals, recognition of other exposures etc.
- Effectively utilize resources for specific activities required to properly manage claims
such as outside claim representatives, nurse consultants, SIU, IME/Peer review.
- Verify the nature and extent of injury by obtaining and reviewing appropriate records.
- Keeps effective diary management system to ensure that all claims are handled timely.
- Medically manage claims by regular interaction with the eligible injury party and or their
attorney and medical provider to establish causation of the injuries, medical necessity of
treatment and the treatment plan.
- At required time intervals, evaluate exposure, and establish proper indemnity & expense
reserves. Utilize evaluation documentation tools in accordance with department
guidelines.
- Maintain claim files, have an effective diary system, and document claim file activities in
accordance with established procedures.
- Identify subrogation opportunities for proper referral.
- Appropriately deal with information that is considered personal and confidential.
- Compliance with Claim Department''s Best Practices and Financial Guidelines.
- Assist the office in being highly productive by handling a workload consistent with
current workload standards and assisting in other areas, as needed.
Knowledge and Skills:
4 year degree preferred
Medical billing practices and prior claims handling experience preferred
Knowledge of medical terminology
Strong organization, communication and customer service skills necessary
Ability to multi-task
Technical skills
Relationship Management
Technology
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