Analyze routine insurance claims to determine the extent of the insurance carrier's liability and to settle claims in accordance with the plan provisions.
- The Claims Specialist sets adequate reserves to ensure proper reporting.
- 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.
? Property and casualty claims review?
? Must have 1-2years of experience
? 6monthsexperience with Claims license
? Candidate with Bachelors degree are preferred