Claims Support Job Description

Claims Support Job Description

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Claims support provides training support and guidance for cost-effective claims review, processing, and service; develop in-house expertise in medical claims coding and support staff’s pursuit of trainings and certifications.

Claims Support Duties & Responsibilities

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

Sample responsibilities for this position include:

Provide daily phone coverage for the Claims 800 number to service and support Travel Insured customers and travel agents
Completes general claims processing to include verification of coverage, OFAC search, ordering police reports, fire reports and completion of ISO reports
Review claim support test protocols
Review claim support data
Distribute approved data reports
Lead cross-functional team of Legal, R&D and Marketing
Handles various provider authorization projects which include researching, resolving, and documenting provider authorization issues
Handles RCM authorization and intake changes required for claims and billing processing within a 48 hour turn-around time frame
Analyzes data and determines if CareCentrix guidelines have been followed by CSC when providing authorizations to providers by researching plan, eligibility, and patient authorization information
Tracks CSC errors and communicates to up-line management for coaching and training purposes

Claims Support Qualifications

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

Licensing or Certifications for Claims Support

List any licenses or certifications required by the position: CECRL, B2, EPIC, B1

Education for Claims Support

Typically a job would require a certain level of education.

Employers hiring for the claims support job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Business, Education, Administration, Management, Finance, General Education, Accounting, Healthcare, Associates, Information Technology

Skills for Claims Support

Desired skills for claims support include:

Medical terminology
Excel and Word
Claims systems
Coverage
Medical terminology and coding
Proprietary software and other technology
Policies
CPT and DRG coding
ICD-9/ICD-10
Industry best practices and policies

Desired experience for claims support includes:

Creates or modifies authorizations when necessary based on individual provider and carrier contracts
Performs analysis on possible recoupments and processes recoupments
Participates in special projects and performances other duties as assigned
Handles NCC, NBC and PRT authorization and intake changes required for claims and billing processing within a 48 hour turn-around time frame
Analyzes data and determines if CareCentrix guidelines have been followed by CSCs when providing authorizations to providers by researching plan, eligibility, and patient authorization information
Conducts basic interviews with external stakeholders

Claims Support Examples

1

Claims Support Job Description

Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of claims support. 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 support
  • Interpret a variety of policy provisions and apply the interpretations to complex claim situations, which require a broad understanding of insurance products other insurance functions outside the Claims department
  • Analyse claims to determine liability and minimise exposure to the company
  • Assist customers by setting up claim first notices, advising on requirements for a complete submission of required documents and the process for sending applicable claim forms by email and/or mail
  • Provide accurate and timely answers to routine claim inquiries with appropriate notations in the TIC diary
  • Serve as customer advocate in all interactions to provide an outstanding customer experience
  • Support department objectives and service levels
  • Document complex inquiries and claim status calls and forward to the appropriate claim unit member
  • Perform other related duties as needed to fulfill job and unit needs
  • Embrace and practice Pete’s Principles
  • Conducts weekly quality audits
Qualifications for claims support
  • Ability to communicate information verbally and in writing so that others will understand the message being conveyed
  • Demonstrated knowledge of and familiarity with Microsoft office software
  • One to two years of prior customer service experience
  • Familiarity with claims, imaging and workflow systems is a plus
  • High school degree or equivalent, AA preferred
  • Minimum 1 year prior administrative or clerical support experience
2

Claims Support Job Description

Job Description Example
Our growing company is looking for a claims support. 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 support
  • Ability to build a rapport with Claims management to gain an understanding of the needs of the business units
  • Update Merimen with PSEA claim number and assign to CHs (in case of non-auto assignment)
  • Reserving in accordance with the Initial Reserve Annual Review Guidelines
  • Uses intermediate skills and business knowledge to prepare insurance forms/documents (identification cards, certificates, endorsements, schedules, ), correspondence and process other insurance transactions to provide customer service and support efforts to acquire and retain profitable business
  • Performs other related support duties as requested, such as answering phones, processing mail, assisting customers, scanning, photocopying and insurance check processing (e.g., returning-and-canceling checks)
  • Works with team leads to ensure service level metrics are achieved through regular scheduled and just-in-time coaching
  • Works to ensure all staff metrics are created/adjusted as necessary clear communication to all staff around expectations
  • Support leads on escalated interactions to include tracking, trending and appropriate strategic business recommendations
  • Keeps abreast of technological and industry developments/ best practices
  • Processing of all direct reports timecards and ensuring all associates are completed meeting all appropriate deadlines
Qualifications for claims support
  • Strong active listening skills demonstrated by giving full attention to what other people are saying
  • Experience in analyzing trends
  • Prior insurance or office support experience preferred
  • Ability to assign, direct, and evaluate the work of staff members
  • Scan and upload all claims-related documents in Merimen/EDMS as necessitates
  • Record and archive all important documents through Crown on a weekly basis (clear desk policy)
3

Claims Support Job Description

Job Description Example
Our growing company is searching for experienced candidates for the position of claims support. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for claims support
  • Determines and assigns incoming claims to appropriate Central Property Claims Unit (CPCU) and/or Personal Property Claims Unit (PPCU) adjusters
  • Follows procedures to reassign, void, create EDI report when needed
  • As assigned, may conclude minor claims within limit of authority as assigned and supervised by management
  • Assists Property Claims department with chargeable expenses and creates associated drafts and letters to accounting to ensure the applicable expenses are allocated back to the appropriate claims files
  • Fully engages in customer focused training
  • Coaches and mentors new hires to enhance their skills, knowledge, and effectiveness as Claim Specialists
  • Assesses and provides information, trends, and observed behaviors of assigned team members to the STD Unit Leader
  • Accesses systems
  • Assigns Subrogation Losses to Adjusters
  • Does Subrogation Billing
Qualifications for claims support
  • Exposure to management level would be ideal
  • Able to handle high volume of work with speed and accuracy
  • Knowledge of health care terminology and medical claims processing
  • Knowledge of CMS1500, UB04, UB92 and ADA Dental claims processing procedures
  • Knowledge of HIPAA and other statutes and regulations concerning privacy and security of medical information
  • Knowledge of conventional data information systems
4

Claims Support Job Description

Job Description Example
Our growing company is looking for a claims support. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for claims support
  • Answers the phones, indexes claims, re-directs calls to appropriate parties
  • Does any special projects requested by managers
  • Monitor outstanding assignments
  • Follow up on outstanding assignments
  • Maintain supplement hot line
  • Sets reserves for Salvage
  • Review total loss report for open rental assignments
  • Update appraisal assignments and/or AS400 with updated information
  • Moving vehicles to Copart
  • Resolves complex organization and technological problems
Qualifications for claims support
  • At least two (2) year’s experience working in an office environment
  • Knowledge of administrative procedures and software applications (such as Microsoft Office Word, Excel, PowerPoint)
  • Education equivalent to a graduation from high school, or the equivalent in related work experience
  • Years of general office experience or years’ experience in a support role involving property/casualty claims are preferred
  • Possess the ability to work in a team environment and demonstrates strong relationship-building skills, initiative, work prioritization, and organizational skills
  • Must be comfortable in initiating first contacts with insureds and other parties and performing initial file work before referral to adjuster
5

Claims Support Job Description

Job Description Example
Our company is looking for a claims support. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for claims support
  • Problems solve for complex operational processes and research determining root cause of metric variances
  • Create responses for the Florida attorney disclosures, as required by Florida Statute 627.4137
  • Mail requests for medical and lost wage verification documents, PIP applications and affidavits to parties seeking benefits
  • Monitor and provide calendar updates to management
  • Ensure timely completion of deadlines are met
  • Respond to EOB requests via fax, email and mail
  • Order claim reports and ensure they are imported into the Adjuster Alert document system
  • Review unmatched billing to locate and match to an existing claim or set up a new loss
  • Assist with tasks in the bill review system as needed
  • Handle incoming and outgoing faxes and ensures proper distribution of documents
Qualifications for claims support
  • Ability to use software and hardware peripherals related to job responsibilities including MS Office Suites, Word, Excel, Outlook, Internet searches
  • Coordinates licensing function and ensures that producers (agents, brokers/or direct sales representatives) remain licensed in accordance with company and state regulations and procedure
  • Translates and interprets state regulations and informs producers of licensing requirements
  • Establishes and maintains files/database reflecting producer licensing status
  • Ensures accuracy of work and reconciles various problems/discrepancies with full responsibility for resolution
  • Provides internal and external customer service regarding inquires, providing information

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