Insurance Claims Job Description
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:
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:
Desired experience for insurance claims includes:
Insurance Claims Examples
Insurance Claims Job Description
- 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
- 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
Insurance Claims Job Description
- 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
- 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
Insurance Claims Job Description
- 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
- 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
Insurance Claims Job Description
- 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
- 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
Insurance Claims Job Description
- 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
- 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