Claims Coordinator Job Description

Claims Coordinator Job Description

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Claims coordinator provides orientation, oversight, direction, supervision, and mentoring to medical office staff on a day-to-day basis and ensure adequate coverage of medical office staff and steps into their responsibilities during an absence.

Claims Coordinator Duties & Responsibilities

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

Sample responsibilities for this position include:

Analyze police reports, beneficiary statements and physician statements
Coordinate and review records and documentation needed for Plan F Reviews and Accelerated Death Benefit eligibility decisions
Take lead role regarding all claim activity with internal and external customers, including recommendations to the Claims Committee
Prepare and compile accounting journal and other accounting materials
Research outages and aging transactions
Take actions to correct outages and aging transactions
Perform money movement functions on general ledgers and sub ledgers
Utilize investigation skills to resolve accounting issues and identify solutions
Assist customers, banking offices and Customer Service with inquiries related to debit card claims
Process and adjudicate paper, electronic and scanned claims for multiple benefits and tier plans

Claims Coordinator Qualifications

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

Licensing or Certifications for Claims Coordinator

List any licenses or certifications required by the position: MA, CPC, W-9, DICM, RHIA

Education for Claims Coordinator

Typically a job would require a certain level of education.

Employers hiring for the claims coordinator job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Education, Business, Healthcare, Accounting, Management, Associates, Business/Administration, Science, Graduate, Construction

Skills for Claims Coordinator

Desired skills for claims coordinator include:

Managed Care pharmacy claims processing
Medical terminology claims codes
Prescription drug products and Over The Counter drugs
Familiarity and ability to use pharmacy reference books
Medical disability management
Microsoft Office applications
State and federal FMLA regulations
Medical terminology
Microsoft Office products
Coaching and mentoring techniques to be able to develop and support others on a day-to-day basis

Desired experience for claims coordinator includes:

Operate within Managed Care Regulatory Guidelines
Tracks and inputs results into databases
Provides status to Human Resources, Safety, First-Aid and various departments with regard to disability tracking of the injured worker to comply with FMLA and OSHA requirements
Verifies wages, work restrictions and work injuries
Coordinates with T.V
IEA Workers’ Compensation Certificate preferred

Claims Coordinator Examples

1

Claims Coordinator Job Description

Job Description Example
Our company is growing rapidly and is looking for a claims coordinator. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for claims coordinator
  • Determines liability, adjusts and settle self-administered General Liability claims
  • Completes and/or coordinates investigation of liability incidents
  • Oversees third party claims administrator handling the Company’s liability claims through settlement
  • Manages requests for subpoenas and other legal matters, including lawsuits
  • Identifies and pursues opportunities for loss subrogation
  • Leads and coordinates claim reviews with third party claims administrator
  • Assists with projects and produces miscellaneous statistical reports as required for Management and Safety
  • Helps identify and maintain an effective General Liability claims program
  • Assesses loss exposure, coordinate all aspects of a property damage loss, pursue all recovery opportunities
  • Identifies and analyzes General Liability claim trends, determine and implement suggestions to reduce frequency and severity of losses
Qualifications for claims coordinator
  • 1-2 years' experience processing and adjudicating medical claims in a managed care environment
  • Prior experience independently reviewing simple to moderately complex claims for adjudication purposes
  • Must possess strong attention to detail and accuracy
  • Ability to convey ideas clearly and concisely in both written and verbal communications
  • General insurance coverage and policy analysis skills, including ability to make coverage determinations
  • Knowledge of General Liability programs and excellent claims management skills
2

Claims Coordinator Job Description

Job Description Example
Our innovative and growing company is hiring for a claims coordinator. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for claims coordinator
  • Function as a critical liaison to CAG, RCCA and CAG Mumbai claims personnel to increase the connectivity between FINEX and these claim units
  • Take a leadership role in the cross training of FINEX, CAG, RCCA and Mumbai claims personnel
  • Position FINEX to effectively leverage existing resources in CAG, RCCA and CAG Mumbai to handle MM claims and L&C claim reporting
  • Triage claims and develop protocols to ensure that claims are seamlessly transitioned to the appropriate claim unit and in certain situations, flagged for escalation treatment
  • Increase the efficiency of the FINEX claims operation by managing the transition of the L&C claim reporting function from the Claim Advocates themselves to Mumbai
  • Coordinate the blending of the Mumbai FINEX and CAG Mumbai claim operations to increase overall efficiency and provide FINEX with deeper access to claim personnel in Mumbai CAG
  • Train FINEX claims personnel on the CAG claims system
  • Evaluate application of EPIC to FINEX claims operation, lead any related training and perform EPIC data input
  • Types general correspondences, memos, charts, tables, graphs, business plans, Proofreads copy for spelling, grammar, and layout, making appropriate changes
  • Ensure customer provides adequate information to process claims
Qualifications for claims coordinator
  • Cost containment skills
  • Ability to interface with various internal departments and external partners and vendors
  • Ability to identify opportunities and trends, and recommend viable solutions & ideas to reduce/contain claim costs
  • Experience and proficiency with Excel, Word, Powerpoint and various claims management systems, including carrier systems
  • 2+ years of Liability claims management
  • Occasional travel to field locations, accident sites and claims offices (estimated less than 3 times/year)
3

Claims Coordinator Job Description

Job Description Example
Our company is growing rapidly and is looking for a claims coordinator. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for claims coordinator
  • Coordinate with H/R and TPA when permanent restrictions accompany the permanent partial disability/medical maximum improvement report
  • Insures proper and timely tests are conducted and results are valid
  • Review and process provider disputes and appeals as established in the Claims Department Policies and Procedures
  • Answering incoming calls from customers and identify the type of assistance the customer needs
  • Analyze and apply denials
  • Process and Review Claims
  • Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member / provider
  • Communicate and collaborate with members and providers to resolve issues, using clear, simple language to ensure understanding
  • Thorough screening and assessment of suspect Household insurance claims
  • Appointing external counter fraud suppliers to assist with investigation of suspect claims
Qualifications for claims coordinator
  • Property and Casualty Broker’s license preferred
  • 5+ years of insurance brokerage experience
  • In depth knowledge of CAG and Mumbai operations
  • Understanding of management liability coverage lines
  • 1 year experience in a high volume fast paced customer service environment
  • 1+ year of previous Claims / Credit Resolution experience
4

Claims Coordinator Job Description

Job Description Example
Our company is hiring for a claims coordinator. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for claims coordinator
  • Managing a case load of suspect claims through to conclusion, including agreeing and arranging settlement with policy holders and their appointed representatives
  • Ensuring relevant material misrepresentations are referred to Claims Underwriters
  • Advising underwriters of any appropriate action required in respect of policies following claims investigations
  • Accurately recording fraud savings
  • Provide assistance to management to develop techniques to enhance detection and prevention of fraudulent claims
  • Act as claims point of contact (both internal and external) for Household fraud matters
  • Preparation of statements and evidence packs for proven fraudulent claims for referral to IFED
  • Assist in preparing and delivering fraud training
  • Ensure suspect claims are run through relevant databases
  • Understand referral processes, referral criteria and authority levels, and ensure these are strictly followed
Qualifications for claims coordinator
  • Excellent interpersonal skills necessary to handle sensitive and confidential information, and to interact with a diverse patient population, providers and staff
  • Strong PC and software application skills
  • Advanced analytical ability is required in order to gather and interpret data , and resolve moderately complex problems
  • Post high school education with emphasis on business-related skills and/or technical, electric or gas utility experience beneficial
  • Knowledge of health/managed care insurance claims which reflect knowledge of institutional/professional claims and Correct Coding initiative
  • Pharmacy Technician with ARx experience required
5

Claims Coordinator Job Description

Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of claims coordinator. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for claims coordinator
  • Ensure that we are TCF and act in a professional manner at all times
  • Meet and exceed departmental Key Performance Indicators and targets
  • Work within the managed care section to ensure issues related to medical claims are addressed in a timely manner to
  • Ensure contract compliance by each managed care organization (MCO), timely and responsive MCO and provider support
  • Communicate with providers and other external stakeholders to improve care delivered and to address Medicaid programmatic issues
  • Serve as liaison with the MCOs and LDH MMIS, Eligibility and Systems staff to address questions and complaints related to claims issues
  • Review monthly denied claims reports and provide analysis to provider relations program manager
  • Assists branches in routine claims issues , who to call, where to send information, the role of our Third Party Administer (TPA)
  • Assists the TPA when requested information from branches is not provided timely, the TPA is unable to locate the claimant
  • Perform a variety of duties for functional groups being supported by the Administration Operations team which allows the office to function at a high level of efficiency and compliance
Qualifications for claims coordinator
  • Third Party experience
  • Excellent PC skills – Microsoft Office, Excel, Access, Outlook
  • Ability to work in a team environment and adapt easily to constant change
  • Math skills at a proficient level -work well with numbers and percents
  • Handle multiple open tasks
  • Ability to manage time efficiently and stay organized

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