Claims Operations Analyst – Commercial Insurance

Role Title:
Claims Operations Analyst - Commercial Insurance

ECLARO:
A quick Summary

ECLARO is an award-winning professional services firm headquartered in New York City and operating in the U.S., Canada, UK, Ireland, Australia and the Philippines. We are dedicated to a singular purpose: providing the Right People to meet every client's needs and solve business challenges through strategic staffing, permanent placement, custom outsourcing & offshoring. Utilizing our proprietary TRINIT-E Service Maturity Model, we help clients implement programs to promote innovation, automation and process improvement.

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.

Technology/Systems:
Advanced knowledge of Claims systems, document management solutions, downstream data and reports is required to ensure quality, compliance, service, and accuracy. Technical acumen, knowledge of TPA systems and data feeds, financials and claims workflows required.

Service/Engagement:
Provide customer service for the claim department. As directed by Claims management and authorized adjusters, provide comprehensive, and relevant responses to questions and concerns from underwriters, insureds, claimants, brokers, attorneys, vendors, claims adjusters, etc. Support TPA's (3rd party adjuster) with communications, interfaces, data transfers, service levels and reporting. Ensure the needs of Brokers and Insureds are met with Risk Management system interfaces, deductible tracking and billing, SIR tracking, collateral, International support, special handling instructions, account/location coding and more.

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

Competencies:

• Innovation-Displays original thinking and creativity; Meets challenges with resourcefulness; Generates suggestions for improving work; Develops innovative approaches and ideas.

• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.

• Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Supports everyone's efforts to succeed.

• Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.

Requirements:

• College degree preferred

• 8 + years in Commercial Claims

• Ability to exercise independent judgment and make critical business decisions effectively.