Claims Service Specialist

Claims Service Specialist

The Claims Service Specialist will support the Claims Services Managers (CSM's) to help ensure member claim service satisfaction and provide claims service management ensuring proper communication and follow through.

ESSENTIAL EDUCATION AND EXPERIENCE:

Bachelor's Degree or equivalency in a related discipline and at least three (3) years of claim handling experience and claims customer service. Must have direct client service experience in commercial claims either through face-to-face or telephonic interactions.

SKILLS/COMPETENCIES REQUIREMENTS:

• Strong customer service orientation.
• Organization, planning, and prioritization expertise with strong skills in multi-tasking and follow-up.
• Proficiency with Microsoft Office and ability to learn RMIS based claims systems.
• Works well independently and in a team environment.
• Excellent written and verbal communication skills.
• Comfortable in a client facing role.
• Strong analytical, problem solving, judgment, and communication skills.
• Willingness and ability to travel domestically at a minimal amount as required.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Act as a shared resource in supporting the Claims Department on member onboarding, member requests, claim reviews and other matters supporting the Claims service function.
• Act as a liaison between the Claims Services Manager, member, broker and the claims administrator on claim and customer service matters.
• Regularly engage with clients to address questions and opportunities and ensure a transparent and supportive communication channel throughout the claims process.
• Maintain accurate and organized records of activities, outlining ongoing client communication, history of escalations and opportunities. Prepare detailed reports for review and analysis.
• Coordinate member / broker calls to ensure all claim and captive related questions and concerns are addressed.
• Actively provide Claims Services Managers various updates on any ongoing issue or question from a member/broker.
• Backup the Claims Services Managers (CSM's) specifically with client claim review virtual and telephonic conference calls.
• Guide conference calls with service providers and clients to ensure a smooth and productive claim review takes place.
• Compile and distribute Large Loss Notices to captive CSMs and Captive Executives when necessary.

PRIORITIES: Positive customer service and proactive claims service management ensuring proper communication and follow-through, as well as supporting the Claims Dept as needed to help ensure member claim service satisfaction.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.