Claims Specialist

New York  ‐ Onsite
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Description

POSITION SUMMARY:
  • Analyze routine insurance claims to determine the extent of the insurance carrier's liability and settle claims in accordance with the plan provisions.
  • The Claims Specialist will be handling Leisure Travel claims.
  • The position involves reading Medical Records and reviewing Policy Terms and Conditions in order to determine the validity of a claim.
ESSENTIAL DUTIES:
  • The Claims Specialist sets adequate reserves to ensure proper reporting.
  • Processes claims and makes decisions.
  • Compares data on claim form with insurance plan to ascertain completeness and validity of claim.
  • Examines claim form and other records to determine insurance coverage.
  • Proactively works to resolve claim as expeditiously as possible.
  • Reviews and analyze detailed medical records.
  • Calculates reimbursement of benefits according to the schedule of coverage.
  • Runs various claim reports as directed by the account.
  • Approves claims at the appropriately demonstrated assigned authority level.
  • Handles difficult phone calls.
  • Composes special correspondence.
  • Works on special projects and tasks as assigned.
  • Other duties as assigned.
We are looking for experienced claims adjusters with at least 2+ years of actual claims adjudication experience processing either No-Fault, Bodily Injury, PIP or Workers Comp claims, college degree preferred.
REQUIRED SKILLS AND EXPERIENCE:
  • Claims adjudication experience or relevant Berkely experience.
  • Writes clearly, concisely and effectively.
  • Communicates verbally effectively and with impact.
  • Computer literate.
  • Detail oriented.
  • Ability to multi-task Manages time effectively.
  • Committed to superior customer servicing.
  • Ability to work independently, a self- starter
  • Excellent written and oral communication skills.
  • Excellent organizational skills.
  • Professional.
  • Ability to work in a fast paced environment.
  • Ability to review medical records
  • Prior experience working on No-Fault, Bodily Injury or Workman's Comp claims is very beneficial.
  • Associates degree, or higher.
Start date
n.a
From
Synectics
Published at
11.07.2015
Project ID:
942483
Contract type
Freelance
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