The Claims Specialist is responsible for assisting in the cost effective administration of claims; monitoring customer service levels to ensure delivery of high quality service; effectively responding to both internal and external customer inquiries and complaints; and, monitoring activities of vendors who support claim operations, as needed. The Claims Specialist provides claim and loss reporting to, and interacts with, other departments; gathers appropriate documentation of processes; and, communicates with respect to the investigation and assessment of liability and damages within established authority.
PRIMARY DUTIES AND RESPONSIBILITIES:
- Effectively assist Third Party Administrator with handling claims to conclusion.
- Provides high quality customer service by determining the best approach for handling issues.
- Processes documents and inputs information into the database.
- Gathers claim file material from multiple sources including internal and external parties. Analyzes claim file material for potential impact on claim mitigation.
- Initiates and conducts follow-ups via proficient use of the claims handling system or other related systems.
- Utilizes Risk Management best practices.
- Submits statistical reports as required.
- Manages vendors, as assigned.
- Other duties as assigned.
SKILLS, KNOWLEDGE AND ABILITIES:
- Focus on quality work and job performance
- Must be able to multi-task, be well organized and detail oriented
- Must be proficient working with database and processing software, excel, word and outlook
- Must have mathematical, problem solving and analytical skills
- Must have good written and verbal communication skills
- Must be able to successfully complete licensing and claims certification schools/classes, where required.
REQUIRED EDUCATION AND EXPERIENCE:
Education: High School Diploma required. Undergraduate degree preferred.
Years of Experience: 2 years relevant experience
This job operates in a professional office environment. This role requires a minimum work week of forty (40) hours, Monday through Friday, with occasional overtime in excess of forty (40) hours. Ability to travel required.
MACHINES, TOOLS, EQUIPMENT AND SOFTWARE USED:
- Multiple software applications.
- MS Office Suite
- Pen and paper
TYPICAL PHYSICAL DEMANDS:
- The ability to organize various office systems through adjusting, connecting, lifting, pulling, pushing, bending or folding for the purpose of proper records development and/or management.
- Ability to use a computer and related devices, such as a keyboard or mouse or other related equipment, throughout the day while seated at a workstation.
- While performing the duties of this job, the employee is regularly required to speak or hear. The employee is also frequently required to stand, walk, use hands and fingers, handle or feel and reach with hands or arms.