Insurance Claims Job Description

Insurance Claims Job Description

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Insurance claims provides managed care consulting support to clients including the review of client medical operations, claims, and data.

Insurance Claims Duties & Responsibilities

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

Sample responsibilities for this position include:

Will be responsible for adjudication of all types of medical claims based on contractual policies and procedures when needed
Leads the claims team by coaching, mentoring and developing those Associates
Will be responsible for providing question time to all claims processors
Services as a subject matter expert on policy, workflow and technical issues for the claims team
Will work closely with claims auditors to analyze audit errors and implement action plans as needed
Responsible for working with claims auditor to increase or decrease audit percent for individual associates
Independently analyzes and makes decisions on non-clinical complex claims
Eligibility Verification (commercial insurance, Medicaid, contract payers)
Become an in-house expert on all claims-related matters
Answer questions on the adjudication process and individual claims

Insurance Claims Qualifications

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

Licensing or Certifications for Insurance Claims

List any licenses or certifications required by the position: CCS, THIT, RHIA, ARM, CPCU, CRCE-I/CRCE-P, CRCP-I/CRCP-P, AAHAM, CII, IICAR

Education for Insurance Claims

Typically a job would require a certain level of education.

Employers hiring for the insurance claims job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Collage Degree in Education, Graduate, Graduate Education, High School Education, Business, Management, Law, Associates, Finance, Accounting

Skills for Insurance Claims

Desired skills for insurance claims include:

MS Access Database
Using Excel
Claims
Settlements & claims processing
Commercial
Microsoft Office
Internet and e-mail
Medicare claims processing and medical review process
Managed care payers and medical terminology
Medicare and Medical Assistance programs

Desired experience for insurance claims includes:

Experience in negotiating contracts, Statements of Work (SOWs) and Pricing structures strong understanding contractual terms and conditions to reduce risk and deliver a high value deal
Must have excellent data entry, typing and computer skills
Minimum 7 years of group or individual insurance experience
Recognised Veterinary qualification - minimum dip V.N or B.sc VN
Strong interpersonal skills, with the ability to communicate at all levels with internal and external customers
Auditing as needed

Insurance Claims Examples

1

Insurance Claims Job Description

Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of insurance claims. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for insurance claims
  • Ensure timely and accurate adjudication of claims
  • Take ownership of all claims processing issues
  • Manage all types of investigative activity on major claims
  • Establishes claim reserve requirements and makes adjustments, as necessary, during the processing of the claims
  • Investigate & resolve Normal Curative Claims
  • Provide status updates and correspond with customer upon receipt and then resolution of claims
  • Ensure accuracy, timeliness and consistency of claims reserves and payments
  • Establish overall budget and staff management, claims handling policies, programs and annual business goals, and implement CAT response strategy and reporting process
  • Aggressively manage claims for multiple lines of insurance such as Workers Compensation, GL, Auto, Property, Ocean Cargo, Transit
  • Review claims to determine coverage
Qualifications for insurance claims
  • Research of all Clinical Activities
  • Claim Preparation and Submission (including verification of service delivery, proper use of CPT codes, understanding of ICD-9 and ICD-10 codes, accurate data entry)
  • Payment Denials
  • Effective and professional communication skills, including both written and verbal
  • Uncover process discrepancies
  • Answer escalated member and provider questions
2

Insurance Claims Job Description

Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of insurance claims. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for insurance claims
  • Handle tender of customer provides claims
  • Responsible for managing and reviewing all claims (
  • Gathers, analyses and records claims data
  • Manages an inventory ofcommercial general and auto liability claims evaluates compensability/liability and losses, and negotiates settlements within prescribed limits
  • Review open lost time workers compensation claims with carrier adjusters for return to work strategy and medical treatment
  • Claims management agency liaison for Workers Compensation specific insurance carrier partners including, but not limited to, AIM Mutual, Applied Underwriters, MEMIC and Atlantic Charter
  • Prepare, facilitate and attend claims reviews with client and carrier
  • Create and submit client first reports to respective insurance carrier claims department for clients on assignment
  • Provide technical guidance to claim team members, Producers and Account Managers concerning Workers Compensation statutes and claims best practices
  • Establish carrier (special claims service handling instructions) for large new agency claim accounts
Qualifications for insurance claims
  • Requires quick thinking, ability to retain large amounts of information, independently motivated, strong keyboard skills and quick processor
  • The incumbent must demonstrate self-motivation and the ability to effectively plan, organize, and complete tasks independently without supervision
  • Experience in best practices or business process improvement
  • The incumbent must demonstrate good people skills, communication skills (both oral and written), and have the ability to work extremely well with internal and external customers
  • Must be open to travel, extensive at times
  • Proficient knowledge in Microsoft Word, Excel, SharePoint, and Outlook
3

Insurance Claims Job Description

Job Description Example
Our growing company is looking for an insurance claims. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for insurance claims
  • Communicate loss analysis results and loss trends to MSR partners, and act as overall MSR partner support contact related to claims activity and client portfolio
  • Responds to Wynsurance Incident Report (IR) or iJet notifications
  • Assists Director with gathering pertinent incident information to determine whether an insurance claim should be opened
  • Sets up all new project files and enters incident data into database
  • Communicates expectations of file quality to franchisees including completeness and accuracy of Record of Drying conditions according to the S-500 standards established by the Institute of Inspection, Cleaning and Restoration Certification
  • Be a current college student in a business related major
  • Be a quick learner and able to learn basic understanding of property insurance policies
  • Be an effective communicator, have excellent customer service skills, and be team focused
  • Providing monthly reporting to casualty management that delivers an accurate current state view of casualty operations
  • Training appropriate parties in use of reporting
Qualifications for insurance claims
  • Bachelor's degree (or the equivalent) with emphasis in related field
  • Minimum of five (5) years of project management or strategic consulting experience in business or process improvement capacity, including use of accepted project management methodologies
  • Demonstrated experience in managing projects which impact a large-scale employee and consumer base
  • Project Management and/or process improvement certification preferred
  • Performance Management certification preferred
  • Experience with fast-paced work environments required
4

Insurance Claims Job Description

Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of insurance claims. 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 insurance claims
  • Provide department & field support
  • Receives & routes incoming claim inquiry calls to appropriate adjuster or department
  • Review Rental & Lease agreements
  • Review, setup and prepare tender on law suits
  • Maintain Litigation log
  • Identify & distribute mail
  • Handle incoming theft reports & NCIC list process
  • Review all 24/7 accident reports for processing
  • Distribute Insurance ID cards
  • Maintain Insurance Card supply
Qualifications for insurance claims
  • Demonstrated ability to interact effectively across department lines and with all levels of management preferred
  • Strong consulting and systems thinking skills
  • Excellent presentation skills with strong ability to present both qualitative and quantitative information in a clear, concise and persuasive manner to all levels of the organization
  • Knowledge of architecture, engineering or construction preferred
  • Knowledge of water mitigation/mold treatment preferred
  • Computer literacy - MS Office (esp
5

Insurance Claims Job Description

Job Description Example
Our growing company is looking for an insurance claims. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for insurance claims
  • Monitor and identify risk points that could be improved in order to reduce size & frequency of claims
  • Accuracy and completeness of patient accounts for billing and follow-up of healthcare claims to ensure timely claim adjudication in accordance with Renown policies and healthcare payor rules and regulations
  • Review, evaluation and submission of additional documentation to payors that do not accept electronic claims or require special handling
  • Assists with the development and coordination of loss control activities and compliance with federal and state laws and regulations
  • Facilitate individual claim conference calls between client and carrier for claim updates/strategy recommendations/settlement authority
  • Review and reconcile mortgage insurance curtailment charges for validity
  • Identify applicable delays caused by foreclosure / bankruptcy counsel and / or third party servicers / subservicers
  • Analyze servicing notes, attorney chronologies, loss mitigation plans, state laws, moratoriums, regulations, and LPS Desktop hold/re-projection histories, to determine servicing delay causes and responsible parties
  • Draft and submit warranted loan-level appeals (requesting curtailment reimbursement), and prepare supporting documentation files
  • Negotiate with mortgage insurance companies, third party servicers, or GSE’s, if applicable, upon receipt of appeal denials
Qualifications for insurance claims
  • ICIBS
  • Bachelor's Degree (or the equivalent) with emphasis in a related field
  • Utilize and/or establish analytics, metrics and benchmarking through multiple sources to evaluate loss trends and cost of risk to prioritize resources
  • Must be 18 years or older and have a High School Diploma or GED required
  • 2 year degree in Human Resources, Legal or closely related field
  • Acceptable experience may be substituted tor the education requirement on a year for year basis

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