Claims Coordinator Resume Samples

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ES
E Schulist
Elmer
Schulist
437 Muller Pass
Phoenix
AZ
+1 (555) 833 3972
437 Muller Pass
Phoenix
AZ
Phone
p +1 (555) 833 3972
Experience Experience
Phoenix, AZ
Claims Coordinator
Phoenix, AZ
Tremblay, Lynch and Brekke
Phoenix, AZ
Claims Coordinator
  • Working knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition and grammar
  • Entering claims in our Software (Bond Pro)
  • Monitoring status of all equipment claims by group spread sheet
  • Tracking Loss Adjustment Expenses and Losses
  • Processing Check Requests for Payments
  • Sending Standard Claim Letters
  • Coordinating Claims Meetings with our General Counsel, Consultants, and Claims Department
Boston, MA
WC Claims Coordinator
Boston, MA
Waters, Schoen and Miller
Boston, MA
WC Claims Coordinator
  • Obtains physical restriction from medical provider when worker is released to light duty and prepares light duty job offer letters
  • Assists branches in routine claims issues i.e., who to call, where to send information, the role of our Third Party Administer (TPA), etc
  • Reviews new claims to determine if they involve restricted work, or are an indemnity case
  • Works with outside vendor to arrange light duty offsite if opportunities don’t exist at the branch
  • Detailed oriented and focused on accuracy
  • Facilitates the resolution of issues between the branch and TPA
  • Directs vendor inquiries to TPA
present
Dallas, TX
Industrial Claims Coordinator
Dallas, TX
Williamson-Greenfelder
present
Dallas, TX
Industrial Claims Coordinator
present
  • Work varied shifts, including weekends and holidays
  • Perform other related duties as necessary or assigned
  • Perform ISO Indexes
  • Perform initial claim interview with injured employee
  • Index industrial claims
  • Review, index and approve or deny medical bills from physicians in accordance with Nevada law
  • Schedule medical appointments and generate appointment letters
Education Education
Bachelor’s Degree in Physical Science
Bachelor’s Degree in Physical Science
New York University
Bachelor’s Degree in Physical Science
Skills Skills
  • Strong attention to detail
  • Excellent interpersonal skills – able to work within a team
  • Excellent organization skills – able to prioritize work and meet deadlines
  • Ability to effectively & professionally communicate, whether written or verbally
  • -Strong work ethic
  • Strong interpersonal skills; team player
  • Adaptable and flexible to new situations
  • Ability to navigate computer while on the phone
  • -Proficient in Adobe and MS office products (Excel, Word)
  • -Solid problem solving skills
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15 Claims Coordinator resume templates

1

Life Claims Coordinator Resume Examples & Samples

  • Respond to and resolve customer service requests according to EquiTrust policies in a prompt, efficient and courteous manner for internal and external customers, department staff and other contacts
  • Monitor and analyze state regulatory requirements for administering life claims. Work with Compliance team to assess required administrative policy and procedure changes and leads the implementation of resulting changes to administration practices. Determine impact of claim procedural changes on administration systems, coordinates system changes with IT, conducts claims user acceptance testing and prepares or updates claim procedure manuals
  • Perform claims coordination, processing and examination of life insurance claims and living benefits requests. Process claims from the point of claims receipt through claim payment. Coordinate claim processing among 3rd party underwriting and investigation teams, EquiTrust staff (Legal/Compliance, Actuary) and other intermediaries
  • Analyze police reports, beneficiary statements and physician statements. Create an assessment and provides opinion regarding claim. Align documentation with the underwriter’s assessment, and acts as point person for the decision on recession of the life contract based upon the incontestability according to contract language. Document incontestable claim decision and creates letter to beneficiary/beneficiaries regarding final disposition
  • Coordinate contestable claims, contacting investigation vendor, ordering and retrieving all necessary contestable claim requirements, including attending physician statements, prescription records, etc.; responsible for all required communication to ensure seamless and timely processing of the claim
  • Communicate, on both a written and oral basis, with stakeholders including agents, IMO’s, claimants, beneficiaries and internal departments such as Underwriting, Legal/Compliance and Actuary. Strictly adheres to HIPAA guidelines in all communication
  • Communicate with the reinsurance company upon notification of claim and again upon completion of the claim providing records required for reimbursement. Consult with Actuary to confirm value calculations
  • Coordinate and review records and documentation needed for Plan F Reviews and Accelerated Death Benefit eligibility decisions. Assess documentation for eligibility and living rescissions. Provide summary of findings to management for a decision
  • Maintain and provide management reports on a defined basis regarding the status of each assigned case. Prepare summaries for presenting to claims committee when applicable
  • Take lead role regarding all claim activity with internal and external customers, including recommendations to the Claims Committee. As such, will have significant opportunities to advise and influence others
  • High school graduate or equivalent required; associates degree or college degree in business or other related discipline preferred
  • Six to seven years life insurance experience in claims or underwriting preferred
  • Professional industry designations such as Chartered Life Underwriter (CLU), ICA’s Associate/Fellow Life and Health Claims (ALHC/FLHC), LOMA’s Associate Life Management Institute (ALMI) or demonstrated work toward achieving designations
  • Strong knowledge of life insurance and claims processes, taxation aspects (MEC, TAMRA, Guideline Premium Tests) and basic understanding of medical terminology as related to life insurance required
  • Ability to prioritize workflow, establish and meet deadlines, manage multiple concurrent tasks
  • Ability to learn quickly and understand complex administration systems
  • Proficient computer skills, including keyboarding, with knowledge of MS Word and Excel and have used an insurance administration system
  • Responsible, reliable, dedicated and accountable
  • Organized, self-directed
  • Team oriented
  • Professional communication and diplomacy
  • Innovative and inquisitive
  • Intuitive, problem solver, analytical
  • Strong attention to detail; accurate
  • Demonstrate ability to multi-task and flexibility in scheduling of daily activities
2

Claims Coordinator Resume Examples & Samples

  • Technical knowledge: Knowledge of WC law and excellent WC claims management skills
  • Accomplished in planning and directing multiple projects/assignments simultaneously
  • Excellent working knowledge of Word, Excel and Microsoft Outlook
  • Communication skills: Ability to convey ideas clearly and concisely in both written and verbal communications. Excellent inter-personal skills
  • Physical Requirements: Ability to travel to field locations, accident sites and claims offices
  • Minimum educational level: Bachelors Degree in related field and/or equivalent work experience
  • Experience required: 2+ years of WC claims management
  • Demonstrated success in problem solving
3

Claims Coordinator Resume Examples & Samples

  • Administers Self-Insured medical only claims in compliance with the rules and regulations of the State of California by authorizing treatment and billings, setting medical examinations and acting on all other requests to bring the file to closure. Answers questions and explains workers’ compensation benefits to the employees
  • 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. Duties such as answering telephones, maintaining files/records, etc
  • Verifies wages, work restrictions and work injuries. Contacts doctors and medical providers, authorizing initial medical treatment. 5. Processes checks and runs reports on Self-Insured claims. Performs other
  • Coordinates with T.V. and Feature productions to ensure that the productions complete required state forms and follow procedures
4

Claims Coordinator Resume Examples & Samples

  • Work with contractors, third parties (local police and/or fire depts.) and Company employees to obtain proper accident documentation when it exists
  • Respond to extensive public inquiries on Company or public claims
  • Assist in development and maintenance of information systems and databases
  • Negotiate payment options and billing terms with contractors or customers for claim payments
  • Manage and coordinate the entire billing process; including entry of claim, invoice billing, customer contact and final payment negotiation. Use Passport system for claim entry and use to guide work orders to claim status. Must be properly and timely entered, for payment
5

Claims Coordinator Resume Examples & Samples

  • Maintains effective systems to support the timely release of accurate information to diverse clients
  • Responsible for the intake of all program specific correspondence including mail and faxed documents
  • Logs information into appropriate database and triages all program specific mail to the appropriate reimbursement counselor and/or team leader
  • Responsible for payer research and state assignment management
  • Distributes reports daily disseminating information to appropriate distribution vendors reimbursement counselors and team leaders
  • Complies with all appropriate policies procedures safety rules and regulations
  • Answers basic programing inquiries and triage calls to appropriate team members
  • Strong desire to develop health care research and analysis skills in order to support payer research health care policy library and state management responsibilities
  • Strong computer application skills
  • Must have excellent time management skills
  • Strong interpersonal skills; team player
  • Adaptable and flexible to new situations
6

Claims Coordinator Resume Examples & Samples

  • Prepare and create event and property related claim files, perform any follow up action necessary to resolve any guest/patron issues and secure any additional documentation/video relevant to the event or claim
  • Provide support to the Property Risk Manager in all aspects of general office administration, including conducting research, preparing written correspondence, handling telephone, mail and email
  • Enter and track all certificates of insurance (COI) within the RMX system, provide follow up communication relevant to COIs, and assist with tracking and monitor of all documentation/information pertaining to property fleet schedule
  • Review incoming events and property/loss missing related claims
  • Prepare and create event and property/loss missing related claim files with completion of all necessary follow up action to include communication verbal and written with guests/patrons and retention of any and all pertinent documentation information to include video retention
  • Timely communicate and resolve any guest service issues related to filed events and property/loss missing related claims
  • Provide administrative support to Risk Management Director
  • Manage and screen multi-line phone and direct calls to appropriate parties or take messages
  • Oversee opening, sorting of high volume in-coming (internal and external) mail, including faxes, e-mail and provide necessary response as directed by the Risk Management Director
  • Assist Risk Management Director with maintenance of certificate of insurance program to include data entry of all certificates of insurance into database system (RMX)
  • Assist Risk Management Director with tracking and maintenance of fleet schedule
  • Perform general office duties, such as ordering supplies, arranging maintenance of claims equipment, maintenance of records management program
  • Maintain confidential electronic and hard copy files
  • Perform all duties as deemed necessary for the success of the department
  • At least 2 years of guest service experience in a related field
  • At least 2 years of administrative support experience or equivalent
  • Working knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition and grammar
  • Working knowledge of good guest service principles
  • Proficient in Microsoft Word, Excel, and Outlook
7

Claims Coordinator Resume Examples & Samples

  • Requires a high school diploma or GED
  • A minimum of 4 years of related experience needed to successfully perform the duties of this job
  • Must be able to set goals and meet deadlines
  • Ability to work proactively in a high-paced deadline oriented environment
  • Must be focused and detail oriented
  • Log all customer claims in detail as required by preset standards
  • Timely response to customers with claim notification number that initiates processing of claim
  • Analyze and properly identify / classify claims for appropriate distribution
  • Creation of Credit and Debit and Return Credit documents in SAP as needed
  • Identify duplicate claims / deductions
  • Professionally communicate to customers regarding claim determination with Credit Memo approval number or denial
8

Damage Claims Coordinator Resume Examples & Samples

  • Create a claim to track the status
  • Contact parties involved to acquire information about the vehicle’s condition at each point
  • Work with all parties involved to reach a resolution
  • Assist insurance adjuster in settling claim
  • Acquire photos of damage and estimate
  • Communicate with parties involved on status and what is needed to proceed with claim
  • Make payment arrangements once settlement is reached
  • Assist others in department as needed
  • Make arrangements for payment to customer and collect payment from vendor
  • High School diploma or equivalent experience
  • 1-3 years of related customer service experience; 1 or more years claims handling experience, or equivalent training required
  • Basic understanding of insurance principles including coverage and terminology preferred
  • Written skills to compose clear, succinct descriptions when posting files and drafting correspondence
  • Excellent telephone communication skills, as well as typing skills required
  • Strong knowledge of Microsoft Excel, Word, and Outlook
  • Capacity to multi-task in a fast-paced work environment
  • Effective and persuasive communications skills
  • Addresses conflict calmly, directly and diplomatically
9

Industrial Claims Coordinator Resume Examples & Samples

  • Set up and organize new industrial claims
  • Perform initial claim interview with injured employee
  • Render determinations on industrial claims per Nevada law criteria
  • Authorize requests for medical treatment from physicians if deemed appropriate per Nevada law
  • Schedule medical appointments and generate appointment letters
  • Index industrial claims
  • Review, index and approve or deny medical bills from physicians in accordance with Nevada law
  • Respond to attorney requests for copies of claim files
  • Perform ISO Indexes
  • Calculate average monthly wage payable to injured employee per Nevada law
  • Calculate permanent partial disability award payable to injured employee per Nevada law
  • Enter claim notes on industrial claims
  • Perform other related duties as necessary or assigned
10

Claims Coordinator Resume Examples & Samples

  • Research and respond to telephonic and internet claims/bill status requests
  • Gather all relevant documentation regarding reimbursement inquiries and make initial determinations on resolution
  • Obtain documentation for incorrectly paid claims and make initial determinations on resolution
  • Assist in filing reimbursement appeals; provide timely follow up on outstanding appeals
  • Research unapplied funds and make recommendations regarding payment applications or refunds
  • At least 2 years experience in workers’ compensation-Preferred
  • At least 2 years experience in billing and reimbursement operations-Preferred
  • Bachelors degree OR an equivalent combination of education and experience
11

National Title Claims Coordinator Resume Examples & Samples

  • Working knowledge of title and escrow procedures and/or mortgage industry procedures (preferably 3+ years title and/or escrow experience)
  • Attention to detail is critical
  • Strong computer skills and the ability to use multiple programs interchangeably is key
  • Must be proficient in Microsoft Office (preferably 2010 or higher)
  • Strong organizational skills with the ability to multi task, prioritize and work under pressure
  • Degree preferred. High School Diploma or equivalent experience
12

Claims Coordinator Resume Examples & Samples

  • Duties and Responsibilities
  • Perform post-foreclosure servicing functions as required by MI, investor, insurer, and internal guidelines including
  • HS Diploma or Equivalent
  • 1+ years’ experience
  • Default-related experience is preferred
  • An aptitude for data, reporting, and working with numbers, is desired
  • MS office
  • Familiar with GSE, and Insurer servicing guidelines
13

Trade Claims Coordinator Resume Examples & Samples

  • Receive, process, and attach a high volume of customer claims backup documentation to corresponding claims in a timely and efficient manner
  • Review new claims and initiate claims workflows following a defined process
  • Manage deduction e-mail box processing a high volume of email communication and documentation for the department. Ensure e-mail box is organized and maintained according to department procedures
  • Ensure customer provides adequate information to process claims. Routes incomplete claims to the appropriate internal and external stakeholder groups to gain complete and required claim information
  • Communicate and work closely with the Trade Claims Specialists to ensure sufficient understanding of the customer base
  • Ensure all activities are completed within established SOP timelines
  • Track data and communicate issues to management
  • Continuously make suggestions and recommendations for improvements of all processes and systems within functional area
  • Work effectively and in cooperation with the Trade Claims Specialists
  • At least one year of experience in a high volume transactional processing environment required (examples include Claims Processing, Data Entry Operator, A/P, A/R, Payroll)
  • Must demonstrate initiative to solve issues independently, consistently, and professionally
  • Prior experience working in an enterprise management system (e.g. SAP) preferred
  • Must be detail oriented, possess strong organizational skills, and possess the ability to produce a high volume of work output
  • Strong communication skills; written and verbal
  • Strong computer skills, particularly with desktop computing programs including Excel and Outlook
  • Ability to work effectively and in cooperation with various departments
  • Ability to prioritize work, manage multiple tasks and effectively produce a high volume of work output within department guidelines
  • Willingness and ability to work in an environment with a high level of repetition of tasks
  • Willingness and ability to work overtime as business needs require
14

Claims Coordinator Resume Examples & Samples

  • Cost control for all full and empty equipment- and vessel damages in German ports
  • Claiming and recovering costs from responsible third parties
  • Maintain handling and prevention measures for full equipment damages with relevant parties in ports of Bremerhaven, Hamburg and Wilhelmshaven
  • Coordination of measures between parties involved
  • Handling of full equipment and vessel related damages to reduce claims costs
  • Follow up for short shipments with terminal operators, customer service desks and other internal departments and agencies involved
  • Damage documentation and tracking in relevant systems (RKCL/RKEM)
  • Cost control of all debit notes for relevant claims under consideration for purchase order for FACT finance system
  • Debit third parties for all acknowledged full equipment and vessel related claims
  • Support third agencies for claims recoveries with claims costs statements if other areas than GER cluster is involved
  • Monitoring status of all equipment claims by group spread sheet
  • Ensure proper filing is kept under consideration of legal and company requirements
15

Claims Coordinator Resume Examples & Samples

  • Answer telephone and obtain necessary information from caller to aid in service or provide the appropriate resource to assist the caller in resolution
  • Where assigned contribute to various forms of data tracking related to calls, customer service input, and aiding in the mailing processes of claims
  • Read and route incoming mail. Locate and attach applicable file information and properly place in claim system(s) with corresponding files
  • Ability to prioritize and manage multiple tasks simultaneously and follow through on expectations in a timely manner
  • Reconcile payments to vendors, claims, and expenses when directed
  • Provide general clerical support and other administrative tasks for claims department as needed
  • Performs other related duties as required and assigned
  • High school diploma or higher level of education
  • Good soft skills related to customer service, verbal and written communication skills
  • Good computer skills and attention to detail
  • Must possess the ability to multi-task and move quickly in a demanding and highly confidential environment
  • Must adhere to the highest standard of ethics and professional behavior
  • Must maintain a positive attitude and consistent temperament
16

Claims Coordinator Resume Examples & Samples

  • Daily review of invoices on hold in the Syncada
  • Resolve billing issues with carriers. Root cause determination and corrective action implementation
  • Maintain and review KPI such as invoicing timeliness, accuracy and aging by carrier
  • Liaise with accounting and finance to execute month end close, Cost-To-Serve, CFF, PO management, GL account coding, etc.,.
  • Manage rate updates in Freight Payment system
  • Perform rating audits to ensure rates are updated in TMS and Syncada
  • Lead validation of payment with actual loads in TMS
  • Ensure accuracy of Inbound BOL file prior to releasing to Syncada
17

Os-risk Claims Coordinator Resume Examples & Samples

  • Work with the injured employee to ensure they follow the process
  • Work with supervisors and managers in obtaining appropriate ABM investigative information
  • Partner with TPA to ensure timely and cost effective claims management, throughout the life of the claim
  • Assists in the implementation of claims related programs within the Region
  • Maintains all logs and diary as needed to ensure compliance with proactive claims management initiatives, and statutory requirements. Manage and maintain lost time and medical restrictions in Risk Console, and the Disability Tracker
  • Works closely with TPA to gather information needed to adjudicate claims
  • Works closely with the Regional Risk Manager to identify training needs within the organization
  • Trains personnel on risk related processes and procedures
  • Mitigate expenses and LAP loss costs by reviewing all regional lost time claims for potential return to work opportunities, as appropriate per Region
  • Timely validates, updates all data coding throughout the life of the claim
  • Weekly review and ongoing diary for employees on total temporary disability, temporary partial disability, and modified duty (Disability Report). Develop and update weekly & monthly report on progress, as appropriate
  • Provide wage statements timely to TPA adjuster
  • Coordinate with H/R and TPA when permanent restrictions accompany the permanent partial disability/medical maximum improvement report. This will ensure timely Interactive Process, and moving the workers’ compensation claim to resolution
  • Follow up as required with our H/R & TPA partners, to ensure that temporary modified duty is offered to 100% of employees within 48 hours of physician release, as appropriate
  • Mitigate expense costs to vendors by limiting employee participation in Wellness Center and/or T2W partnership for reasonable accommodations
  • Attend hearings, as needed per jurisdiction
  • Respond and comply with subpoena requests
  • Minimum of 2 years’ experience in Workers’ Compensation and/or Liability claims, or medical management preferred
  • Must possess ability to present training material
  • Bi-lingual in English and Spanish, a plus
  • Must have working knowledge of Microsoft Excel, Power Point and Word programs
18

Medicare Senior Claims Coordinator Resume Examples & Samples

  • Analyzes and renders final decisions of non-clinical appeals according to procedure, state and federal guidelines, benefit plan guidelines, company internal policies and work flows
  • Consults with internal departments such as Clinical, Legal, and Network, as well as company senior management to assure appeal and complaint decisions meet all guidelines and result in customer satisfaction when possible
  • Consults with Account Management and external vendors to resolve high profile, complex appeals and/or complaints
  • Documents process and findings within the Appeals and the Complaint databases, and the company's internal systems
  • Responsible for maintaining the integrity of the company's relationship with client customers by researching, resolving and responding to customer and account inquiries involving adverse determinations
  • Researches, compiles and consults with external review organization and customers as necessary for appeals and complaint process
  • Assists in data gathering and reporting of appeals. Responsible for achieving and maintaining department performance guarantees
  • Contributes to unit and department CQI (continuous quality improvement) processes by participating in unit goal setting, scorecard development and departmental meetings. Meets individual performance standards
19

Claims Coordinator Resume Examples & Samples

  • Filing: Keeping the Claims (electronic) filing system current on a daily basis
  • Entering claims in our Software (Bond Pro)
  • Tracking Loss Adjustment Expenses and Losses
  • Processing Check Requests for Payments
  • Sending Standard Claim Letters
  • Coordinating Claims Meetings with our General Counsel, Consultants, and Claims Department
20

Benefit Claims Coordinator Resume Examples & Samples

  • Three to five years experience in an office setting with related experience, including administrative and/or customer service
  • Skills and Abilities Required
  • Proficiency in Microsoft Office (Word, Excel, Outlook)and related departmental applications
  • Strong data entry and computer skills
  • Excellent communication skills required to help resolve routine problems, answer general questions, and know when to escalate more complex issues
  • Ability to exercise judgment to shift priorities and organize multitasks simultaneously, including handling daily routine tasks
  • Ability to engage in team environments requiring flexibility to adjust to change quickly
  • High level of follow up and responsiveness
  • Background in reinsurance or first-dollar medical claims experience
  • AA/AS or BA/BS college degree
21

Warranty Claims Coordinator Resume Examples & Samples

  • Identifies warranty coverage of equipment repairs based on type of repair and equipment unit for all terminal maintenance locations daily
  • Monitors owner-operator warranty claims ensuring credit to owner-operator accounts
  • Coordinates warranty payments due and vendor payments made with Accounting department; ensures payments due are credited to the appropriate account
  • Enters all warranty claims and credits into the system; tracks warranty claims filed, invoices, payments, credits and "no charge" invoices as well as warranty coverage specifications based on equipment unit; tracks shipped parts under warranty
  • Verifies vendor charges for road maintenance repairs ensuring road maintenance repairs where actually done and billing not duplicated; authorizes payment and submits to Accounts Payable
  • Responsible for the recovery of warranty claims and adjustments
  • Trains, assists and assigns tasks to newly assigned warranty department personnel; assists Warranty & Road Maintenance Supervisor as needed and acts in his/her place during absence
  • Skills: Computer keyboarding
  • Education: High school diploma or GED
  • Experience Required: Three years transportation, diesel parts or warranty experience
22

WC Claims Coordinator Resume Examples & Samples

  • Communicates with and trains the branches on claims reporting requirements, the importance of using preferred medical providers, our Return to Work program, and the overall claim processes
  • Assists branches in routine claims issues i.e., who to call, where to send information, the role of our Third Party Administer (TPA), etc
  • Assists the TPA when requested information from branches is not provided timely, the TPA is unable to locate the claimant, etc
  • Reviews new claims to determine if they involve restricted work, or are an indemnity case
  • On claims involving work restrictions, works with the branch in locating suitable work ASAP
  • Obtains physical restriction from medical provider when worker is released to light duty and prepares light duty job offer letters
  • Works with outside vendor to arrange light duty offsite if opportunities don’t exist at the branch
  • Maintains claim documentation in electronic folders
  • Directs bills and claim related correspondence received to the appropriate TPA office
  • Facilitates the resolution of issues between the branch and TPA
  • Directs vendor inquiries to TPA
23

Senior Claims Coordinator Resume Examples & Samples

  • Knows fundamental concepts, practices and procedures of particular field of specialization
  • Microsoft office products with an emphasis on MS Word and Excel
  • Strong organizational skills with the ability to multi task and work under pressure
  • Typically has 3+ years administrative experience
  • Title insurance preferred
  • Paralegal certification desirable
24

GAP Claims Coordinator Resume Examples & Samples

  • Coordinate and review pending clams, establish new claims in the system and make additional requests by telephone, e-mail, and letter
  • Prepare GAP Claim files for adjudication and assist GAP Claims Adjuster(s) in claims related administrative duties
  • Answer claim related questions via telephone and e-mail in a prompt, professional manner
  • Conduct necessary research to resolve claim issues brought by lenders and internal/external customers
  • Other Job Duties as assigned
25

Claims Coordinator Resume Examples & Samples

  • Preparing primary insurance claims for submission or resubmission
  • Coordinating and/or performing other special projects
  • Reviewing and taking action on key reports related to billing
  • Escalating system issues or trends to key teammates as needed
  • Clinical outcomes consistently ranked above the national average
26

Provider Dispute / Claims Coordinator Resume Examples & Samples

  • To review and process provider disputes and appeals as established in the Claims Department Policies and Procedures
  • To contribute to a fair and positive work environment by treating peers, superiors, subordinates, clients and vendor with professionalism and respect
  • Extensive knowledge in the area of Managed Care claims, with specific knowledge of DMHC and CMS guidelines
  • 4 years of experience as a Claims Examiner or Claims Auditor
  • Initiative – ability to thoughtfully and independently resolve problems
  • Ability to interpret Health Plans Division of Financial Responsibility for both IPA and Hospital Risk as well as interpreting contracts
27

Claims Coordinator Resume Examples & Samples

  • Manage multiple shared mailboxes receiving a high volume of loss correspondence; analyze key attributes within correspondence for the appropriate business unit and/or MRAm department; evaluate and rank as Payment, Cash Call, Recovery, ACH inquiry First Notice of Loss, Update, Litigation/Suit, Encryption, etc. to meet time sensitive Service Level Agreements assigned to each category
  • Analyze each loss correspondence using Reinsurance / Insurance applications, multiple reference materials and structural guides to identify the appropriate Claims Specialist / Claims Analyst; Proficiently provide the accurate line of business and MRAm loss number, if applicable; Determine the appropriate course of action and route the correspondence to internal / external clients using our Workflow, SRC Worksheet, email or alternative per Claim Handling Guidelines
  • Manage high volume Specialty Markets customer service phone lines with an investigative approach to direct callers to the appropriate Third Party Administrator, Specialist and/or Department
  • Extract and manipulate multiple ISO Reports for distribution to Specialty Markets Division and appropriate Third Party Administrator
  • Prepare and refine loss correspondence in Reinsurance / Insurance applications and facilitate with IT the appropriate access to MRAm’s secured FTP site for legal counsel’s review
  • Manage and prepare hard copy/CD Claim correspondence by consulting with the Claims Divisions, Third Party Administrators and/or Micrographics to enforce a paperless environment; Support the Claims Content Stewards to comply with corporate’s Enterprise Content Management strategies
  • Manage critical customer service operations within Claims i.e. – printer maintenance, scanning requests, shipment of federal express, certified mailings, office supplies. Where appropriate, elevate to manager areas identified for improvement to ensure a high caliber of customer service
  • Assist with Claims Assistants and Associates responsibilities during peak intervals
  • Exceptional organizational and independent decision making skills
  • Ability to adapt and navigate in multiple applications and software on an as needed basis
  • Expertise with MS Office Excel, Outlook and Adobe Acrobat
  • Strong ability to multi-task and prioritize high volume emails to meet time sensitive Service Level Agreements
  • Ability to distinguish between Reinsurance and Insurance business
28

Associate Claims Coordinator Resume Examples & Samples

  • Collaborate with the Claims Coordinators to file claims with small parcel carriers
  • Research shipping costs on damaged shipments
  • Work with Customer Service to collect missing data needed to file claims
  • Track and update claim resolutions from carriers
  • Work on miscellaneous Logistics needs as they arise
  • Perform various tasks to support company initiatives and goals
  • Promote a positive office culture and environment
29

Claims Coordinator Resume Examples & Samples

  • At least 1-3 years’ work experience
  • Clear and concise oral and written communication skills
  • Strong numerical skills
  • Excellent organization skills – able to prioritize work and meet deadlines
  • Excellent interpersonal skills – able to work within a team
  • Comfortable and experience working with technology (solutions)
  • Proficient in Microsoft Office tools (or equivalent) – Outlook, Word and Excel
  • Insurance/ claims handling knowledge
30

Claims Coordinator Resume Examples & Samples

  • Ability to remain focused, diligent and productive on each particular matter
  • Ability to effectively & professionally communicate, whether written or verbally
  • Ability to navigate computer while on the phone
  • Familiarity with computer along with Microsoft Word & Excel