Claims Operations Analyst
1 day ago
Claims Operations Analyst
Night Shift
Onsite in Commonwealth Ave., QC
About the role:
This position will be responsible for managing the Claims email box, meeting service level agreements, setting up the claim in ImageRight and the Claims system. Responsibilities include working directly with brokers and/or insureds for details required to complete the setup of the claim. The role will also be responsible for collecting and reporting the necessary data from claim files for mandatory reporting such as Medicare, state fraud reporting, ISO ClaimSearch, etc. Extensive collaboration is required with Claims, brokers, external vendors and insureds. Subsequent transactions on claims such as expense and indemnity payments, vendor payments and contact management are key accountabilities.
Perform critical operational tasks such as:
• Intake, triage, route and assign claims to appropriate resources.
• Comply with all regulatory requirements, company mandates and policies
• Prepare claims correspondence including assigning claim numbers and sending acknowledgement letters
• Properly document claim files, including notes and diaries, documents in ImageRight and claimant details
• Manage and update claims information for changes in status, parties, notifications, filings, etc
• Review and record medical bills, police reports, contracts, legal bills, and other clam file documents
• Complete claims financial transactions including claim payments, vendor invoices, attorney expenses, etc.
• Process and document returned checks, voided checks, credits and other financial transactions
• Run reports for fraudulent claim research; report claims to ISO and other agencies as required
• Run OFAC and other sanctions clearance on claims indemnity and expense payments
Requirements:
• College degree preferred
• 5 + years in Commercial / Healthcare Claims
• Ability to exercise independent judgment and make critical business decisions effectively.
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