Claim Manager Assistant I

Role Overview

• Provide exceptional internal and external Customer Support in a phone support role
• Assist insureds, their representatives, and healthcare providers by supporting the processing of highly individualized claim inquiries
• Professionally and appropriately respond and/or forward inquiries by reviewing the established standards and guidelines
• Ensure smooth transition of claim while monitoring aging of assigned tasks meeting turnaround time standards
• Identify and respond to needs of inbound and outbound callers utilizing active listening skills; professionally and appropriately
• Prepare claims for Claim Manager review and adjudication
• Process and document the daily administrative activities associated with claim notifications including pending, open, and closed claims, utilizing multiple tabs/screens working within a centralized work que
• Responsible for input of accurate and detailed data and notes consistently meeting established standards
• May perform additional duties and/or assist with special projects as required
• File management and organization
• Maintain electronic file management and organization of incoming and outgoing mail including imaging, indexing, classification of documents, file management, etc.
• Critically review all documentation for completeness, credibility, consistency, and order
• Ability to recognize possible process deficiencies and suggest viable solutions
• Meet or exceed all established minimum expectations/metrics and goals for the position
• Meet or exceed standards for productivity and quality as established for the role
• Appropriately process all confidential information abiding by HIPAA privacy laws
• Ensure smooth transition of inquiry to appropriate department if/when necessary
• May perform additional duties as assigned

Requirements

• High school degree or equivalent experience required; business experience preferred
• Prior customer service experience required; insurance or medical background preferred
• Excellent organizational skills with an eye for detail
• Understanding of medical terminology a plus
• Proven interpersonal, verbal, telephonic, and written communication skills
• Must possess a high degree of tact, diplomacy and professionalism when dealing with all types of customers
• Ability to prioritize work using organizational and decision-making skills
• Must be detail oriented with ability to work independently as well as be part of a team
• Solid knowledge of Microsoft Office Products as well as other business-related software
• Ability to learn new system applications quickly
• Ability to quickly apply learned principles to specific and unique circumstances

Benefits

• Medical, dental, and vision plans to support your health and that of your family
• A 401(k) plan with employer matching
• Time‑off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non‑exempt employees
• Paid holidays
• Life insurance and short‑term and long‑term disability coverage