Claims Service Specialist Job Description

Claims Service Specialist Job Description

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Claims service specialist provides coding support and instruction by reviewing ICD-10 diagnoses and CPT procedure codes utilized by practicing physicians.

Claims Service Specialist Duties & Responsibilities

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

Sample responsibilities for this position include:

Process inbound insurance claims for customers over the phone
Comply with all Department of Insurance regulations (multiple states) and statutory requirements
Handles claim files (locates/requests files, files paperwork, reconstructs missing files, moves misfiled documents, sends to other offices)
Other administrative duties as assigned CLK789
Handles casualty claim files (locates/requests files, files paperwork, reconstructs missing files, moves misfiled documents, sends to other offices)
Handles property claim files (locates/requests files, files paperwork, reconstructs missing files, moves misfiled documents, sends to other offices)
Work with customers and deescalate the call to provide great customer service
Handles personal injury/medical payment claim files (locates/requests files, files paperwork, reconstructs missing files, moves misfiled documents, sends to other offices)
Handles unrepresented casualty claim files (locates/requests files, files paperwork, reconstructs missing files, moves misfiled documents, sends to other offices)
Handling calls with 3rd Party vendors requesting money back

Claims Service Specialist Qualifications

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

Licensing or Certifications for Claims Service Specialist

List any licenses or certifications required by the position: CPT

Education for Claims Service Specialist

Typically a job would require a certain level of education.

Employers hiring for the claims service specialist job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and High School Degree in Education, Business, General Education, Health Administration, Liberal Arts, Healthcare, Communications, Economics, Business/Administration, Finance

Skills for Claims Service Specialist

Desired skills for claims service specialist include:

Excel and Word
Internal operations and develops relationships to facilitate workflow
Surrounding area
Commercial
ICD-10 and CPT coding
Insurance
Medicaid
Medical terminology
Medicare products
Processes/principles

Desired experience for claims service specialist includes:

Bachelor’s Degree is a plus/preferred
Bilingual candidates strongly encouraged to appy
High School Diploma/General Education Diploma (GED) with 2+ years of customer service experience
High School Diploma/General Education Diploma (GED), plus three years of customer service experience in an office environment
Experience as a Title Clerk, handling automotive title processing and/or title transfers is strongly preferred
High School Diploma/General Education Diploma (GED), plus at least one year of customer service experience in an office environment

Claims Service Specialist Examples

1

Claims Service Specialist Job Description

Job Description Example
Our growing company is searching for experienced candidates for the position of claims service specialist. 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 service specialist
  • Serving as point of contact for claim owners, auto technicians and Good Hands Repair Network shops on moderately complex and occasionally complex issues related to inspection and schedule
  • You will help guide customers, over the phone, through non-complex auto claims by coordinating vehicle repairs, car rental and ensuring that their claims experience is a smooth as possible
  • Work collaboratively with a team in a fast-paced environment
  • Rotating weekend hours may be required
  • Perform clerical duties, including data entry, filing paper documents, email, calendar management, and word processing
  • Handle claim files (locate/request files, file paperwork, reconstruct missing files, move misfiled documents, send to other offices)
  • Serves as a liaison between the shops, rental vendors, customers, and adjusters, taking appropriate actions as directed to resolve LOU issues and processes surrounding claim payments
  • Review actions needed to assist resolving shop and vendor inquiries relating to LOU
  • Conducts independent, objective file quality audits through a systemic, disciplined approach in accordance with standard operating procedures and provides immediate feedback to the business disciplines key stakeholders
  • Serves as a Claims technical resource to less experienced team members
Qualifications for claims service specialist
  • Previous experience in bookkeeping or billing highly preferred
  • High School Diploma/General Education Diploma (GED), plus two or more years of customer service experience in an office environment
  • Prior military is encouraged to apply
  • Bilingual are strongly encouraged to apply
  • Background in medical processing preferred but not required
  • High School Diploma and/or Bachelors with previous experience in either customer service and/or a professional work environment
2

Claims Service Specialist Job Description

Job Description Example
Our growing company is searching for experienced candidates for the position of claims service specialist. 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 service specialist
  • Produces meaningful observations through synthesizing data from internal and external sources
  • Assists the Regional Claim Centers on complaint resolution, ensures outlined processes are executed, identifies and coordinates training needs with the Training Department, and summarizes action plan to business leaders
  • Collects operational, product and financial data
  • Reviews and analyzes business unit reports to identify root causes and implement improvements
  • Diagrams and evaluates existing processes and develops future state direction that maximizes efficiency and technology
  • Build strong, lasting relationships with healthcare professionals
  • Promotes positive public relations including maintaining a professional attitude and approach with providers and other payers
  • Contact providers to explain and resolve overpayments and arrange for payment or adjustment processing
  • Follow up on claims recoveries in a timely fashion as outlined in departmental policies and procedures
  • Document information in appropriate systems, including completion of call logs and recovery tracking in Excel
Qualifications for claims service specialist
  • Previous processing experience is a plus
  • Construction knowledge a plus
  • Able to prioritize tasks and provide excellent customer service
  • High School Diploma/GED and/or Bachelor's degree with previous experience in either customer service and/or a professional work environment
  • Previous experience handling or processing vehicle titles strongly preferred
  • High School Diploma/General Education Diploma (GED),with 2 years of previous cusotmer service experience in the medical industry, preferred
3

Claims Service Specialist Job Description

Job Description Example
Our growing company is looking to fill the role of claims service specialist. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for claims service specialist
  • Maintain regular contact with necessary parties regarding recovery status
  • Comply with federal and state laws, company and department policies and procedures
  • Join a team who is dedicated to AAA members and one another
  • Work at a place that has been named one of the 50 Most Community-minded Companies in America for 5 years running
  • Be a part of an organization dedicated to AAA members and one another
  • Join a team dedicated to seeking out and incorporating different perspectives to drive and improve results
  • Work within an organization that has been named one of the 50 Most Community-minded Companies in America for 5 years running
  • Handle personal injury/medical payment claim files (locates/requests files, files paperwork, reconstructs missing files, moves misfiled documents, sends to other offices)
  • Investigate, evaluate, negotiate and settle auto and property damage claims
  • Manages inbound and outbound calls
Qualifications for claims service specialist
  • Experience working with vehicle titles strongly preferred
  • High School Diploma/General Education Diploma (GED),plus experience delivering outstanding customer service
  • Agency Management systems experience
  • Ability to solve problems and work well independently
  • Auto title experience preferred
  • Ability to speak effectively before groups of customers or staff members of the organization
4

Claims Service Specialist Job Description

Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of claims service specialist. 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 service specialist
  • Connects with customers or other claim related third parties to obtain and/or provide necessary file information to align with quality and process standards
  • Completes all required forms, logs documents into the system, and routes them to the appropriate parties
  • Participates in or assists in training new or less experienced employees and demonstrating work processes for shared success
  • Take ownership of pending claims, analyze documentation and settle basic, straight-forward, and routine claims efficiently and effectively
  • Deliver exceptional and courteous customer service
  • Support adjusters in managing information to ensure positive customer experience
  • Work collaboratively with others in a fast-paced environment
  • Achieve targeted performance goals to support Encompass's industry leading operation standards
  • Learn different processes within the claim department to support change
  • Handle a high volume of calls and assist customers with their inquiry
Qualifications for claims service specialist
  • Knowledge of Microsoft Word, Excel, and Outlook preferred
  • High School Diploma/GED required and/or Bachelor's Degree with previous experience in either customer service and/or a professional work environment
  • Construction or property claims knowledge a plus
  • High School Diploma or GED required and/or military experience with an E-4 or better ranking
  • Previous medical billing experience is a plus
  • Previous experience using NextGen is plus
5

Claims Service Specialist Job Description

Job Description Example
Our company is looking to fill the role of claims service specialist. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for claims service specialist
  • Achieve career growth by continuously developing your skills through on-the-job experience, exposure to others and one-on-one mentorship
  • Intern at a place that has been named one of the 50 Most Community-minded Companies in America for 5 years running
  • To deliver backroom operational support for Self-Service Banking (SSB) by resolving SSB machine and system issues
  • To liaise with vendors and internal stakeholders
  • To manage huge amount of data for data analysis
  • To commit to daily, weekly and monthly deadlines
  • To streamline existing work procedures and workflow
  • Compassionately asks effective questions to understand customer, agency and shop needs and resolves appropriately
  • Collaborates with vendor to assist in obtaining information to manage alternate transportation
  • Builds rapport with repair facilities to determine status of repairs and minimize impacts to customers
Qualifications for claims service specialist
  • Fluent in Danish and solid English skills
  • High School Diploma or equivalent with previous experience in either customer service and/or a professional work environmen
  • Must have demonstrated ability to stay organized and mulit-task
  • Availability for a Tuesday – Saturday work schedule
  • High School Diploma/General Education (GED) with previous experience in either customer service and/or a professional work environment
  • High School Diploma/General Education Diploma (GED) with one year of customer service experience in an office environment is preferred

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