Claims Associate Job Description

Claims Associate Job Description

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Claims associate provides support to the Director of Academic Partnerships (MS Word, Powerpoint, and Excel projects, etc.).

Claims Associate Duties & Responsibilities

To write an effective claims associate job description, begin by listing detailed duties, responsibilities and expectations. We have included claims associate job description templates that you can modify and use.

Sample responsibilities for this position include:

Gather the necessary information from our warehouse management system, to obtain proof of delivery from the appropriate carrier
Review documentation to determine if a credit is warranted, or bill the customer back for invalid claims
Research customer deductions for validity
Utilize JD Edwards and Siebel systems necessary
Communicate with Field Sales, Brokers, Logistic centers, Customers and other departments to audit field sales responses, correct issues that arise and properly clear deductions
Issue credits on JDE or Siebel systems
Investigate and resolve issues related to invalid deductions
Write repay letters and/or bill customers for overages
Maintain files for pending deductions, match claims to create deductions, and follow up on aged items for resolution
Analyze information and data for accounts and suggest methods to minimize deductions

Claims Associate Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Claims Associate

List any licenses or certifications required by the position: ASE, ARM, CPCU, PGI, BCP, ASA, HCPCS, CPT, ICD

Education for Claims Associate

Typically a job would require a certain level of education.

Employers hiring for the claims associate job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Collage Degree in Education, Business, Associates, Accounting, Business/Administration, Finance, Computer, Engineering, Law, Public Health

Skills for Claims Associate

Desired skills for claims associate include:

Social Security and Medicare application procedure as applicable to line of business
First party property claims adjudication as applicable to line of business
Construction basics
MS Word and Excel
Flexible Spending Accounts to resolve billing issues
Legal liability
Insurance coverage and medical terminology is a
English: fluent
Excel and Word
FDCPA

Desired experience for claims associate includes:

Attain 0 balance of deductions over 60 days
Inform managers of unusual deduction or credit issues, and/or trends
Manage claims in accordance with legislation the Safety Rehabilitation and Compensation Act 1988 and self-insurance regulations
Determination of initial and ongoing entitlements to compensation
Work closely with our injury management team to assist injured employees to achieve a safe and durable early return to work
Conduct regular claim reviews with relevant key stakeholders

Claims Associate Examples

1

Claims Associate Job Description

Job Description Example
Our company is growing rapidly and is looking to fill the role of claims associate. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for claims associate
  • The timely and accurate management of this position is essential for the reduction of firm risk and client exposure
  • Uses telephone and web-based tools to access insurance benefit plans and claim/EOB information
  • Contacts designated insurance payers to inquire on statues of appeals
  • Communicates with insurance payers to obtain account information, such as benefits and payment details
  • Escalates unresolved claims through the appropriate payer contact
  • When needed, resubmits demand letters to insurance companies and ensures receipt by insurance
  • Connects with department colleagues to resolve claim questions
  • Acts cooperatively and maintains a professional attitude with co-workers, management and insurance companies
  • Special projects as dictated by management.Adheres to all company policies and procedures including, but not limited to those identified within the Standards of Business Conduct and the Employee Handbook, as may be amended from time to time
  • Work within a team to collect member records
Qualifications for claims associate
  • Conduct reviews of these records by contacting providers
  • Place the results collected into a specific data base
  • Work as part of a team to collect and review member records by contacting providers
  • Enter results into the database
  • Conduct on-site review in the provider office or hospital
  • Organize and prepare records, data entry, database management, and email communication
2

Claims Associate Job Description

Job Description Example
Our innovative and growing company is hiring for a claims associate. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for claims associate
  • Participate in user acceptance testing (UAT) activities to ensure business and system requirements are met
  • Responsible for assigned inventory of files with recovery
  • Processes invoices for various vendors involved in recovery, including attorneys, special investigators, medical experts
  • Processes checks received from adverse parties/payees for payment
  • Responsible for filing, faxing, photocopy, scanning and other general office functions
  • Processes assigned claims and determines benefits due pursuant to the client contract
  • Process subrogation files
  • Handles claim files (locates/requests files, files paperwork, moves misfiled documents, sends to other offices)
  • Investigates claims by determining applicable policy coverage, evaluating damages, and settling assigned claims
  • Communicates with clients via telephone to set up new claims and obtain necessary information
Qualifications for claims associate
  • Is able to manage own workload and determine urgency in a meaningful and practical way in order to meet business requirements and timescales
  • Flexible, with a friendly, positive and willing attitude to working and learning
  • Changes focus quickly as business needs change
  • Previous experience of training, supporting, mentoring others
  • Minimum requirement is GCSE in English and Maths
  • Good computer and keyboard skills
3

Claims Associate Job Description

Job Description Example
Our company is growing rapidly and is looking to fill the role of claims associate. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for claims associate
  • Authorising payment within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements
  • Responsible for reviewing a specific account, policy or relationship, remediating the exposure and then moving on to review the next account without taking on traditional account ownership and relationship servicing that is associated with it
  • Review of wide range of information to properly identify correct ownership of counterparty including but not limited to Aon internal records, Atlas, Companies House, Aon Network information, Post Office records, International Directory Enquiries
  • Identify differing approaches required for the differing account types including but not limited to Lloyds syndicates, Company Stamps, Liquidated Entities, Third Party Claims, Third Party Commissions, Intercompany Offices, Internal Suspense and Hold Accounts and Third Party Providers
  • Be able to communicate effectively with contacts
  • Be able to resolve queries or achieve results without having to fully resolve them
  • Creation of payments in line with existing Payment Control Framework
  • Completion of MI control reports
  • Escalation of issues with XBS or to AON where applicable
  • Achieve compliant results very quickly in order to meet targets set
Qualifications for claims associate
  • Conducts themselves by example adapting positively to support change initiatives
  • Completion of background check and drug screening prior to assignment start date
  • 1+ claim management experience is a plus
  • Claims adjudication experience or paralegal experience
  • Medical knowledge, fluency with assessment terminology
  • Ability to identify priority in work assignment and make multiple decisions per day
4

Claims Associate Job Description

Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of claims associate. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for claims associate
  • Assist the Claims Account Executive to monitor & update claim status & create various claims reports
  • This position will have the responsibility for the review and providing guidance of high exposure claim files to ensure reserves are properly set and maintained, demands are handled appropriately, the litigation process is maintained and regulatory standards are adhered to for compliance
  • The position will also provide guidance to management for the handling, strategy and resolution of claims, including providing authority for settlement
  • This position requires that you will become a subject matter expert in a variety of disciplines
  • This position will also assist in providing guidance to all ACE markets for the handling, strategy and conclusion of complex claims files
  • This position will require that you demonstrate discretion when assessing complex and unique claims
  • The position will require that you work directly with Claims management to communicate trends and patterns on high severity and complex claims
  • This position ensures claims representatives and personnel are effectively delivering legendary service through annual audits
  • Demonstrates and model’s the Club’s mission and values for claims representatives and personnel
  • Establish fair market value of vehicles assisting insurers in claim settlement
Qualifications for claims associate
  • Experience with initial eligibility review of long term care claims
  • Experienced in using Windows applications
  • Knowledge of requirements management and/or prototyping (ALM, Jira, RallyDev, Balsamiq, iRise)
  • Knowledge of and Experience in the business processes and systems that handle Product and Benefits Administration, Claims, Benefit Determination, Accums, and/or Claims Recovery & Appeals capabilities
  • SDLC Methodologies (XP, Scrum, OWF)
  • Requirements Management Tools
5

Claims Associate Job Description

Job Description Example
Our innovative and growing company is looking to fill the role of claims associate. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for claims associate
  • Provide supplemental research as requested
  • Submit ISO “initial” on all new FNOL
  • New mail & faxes - tasks
  • Check disbursement
  • Approve/Review EDI payables
  • Under moderate supervision, works within specific limits and authority to actively manage a caseload of lost time cases of moderate technical complexity in the Nevada jurisdiction
  • Actively manage cases involving medical, legal and vocational rehabilitation issues
  • Knowledge of the claim assignments and claims processing
  • Review and interpret policy coverages
  • Conduct a thorough investigation which will include telephone interviews from the insured, witnesses and others possessing facts concerning the claim
Qualifications for claims associate
  • There may be extended periods of confinement to work station during peak periods
  • High school diploma or AA
  • 1+ years customer service experience as a high-performing customer service/support representative
  • College or University degree or alternatively Associate in Claims qualification
  • Excellent knowledge of coverage forms and god analytical skills in policy interpretation
  • Achieved ACII or equivalent relevant qualification, or legal framework background

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