Under direct supervision, the Claims Technician I performs a variety of duties to ensure the proper execution in the creation of new claims. These duties include but are not limited to communication with the field, policyholders, claimants, as well as co-workers and claim examiners, via telephone, emails, and fax. Must maintain required daily turnaround times for production quotas.
Duties and Responsibilities :
Education, Qualifications and Experience :
- Processes all claim forms in appropriate system (PACS/CAS) based on the Line of Business.
- Utilizes RAD, PACS, RUMBA, DataMart, RSL Insite, FileNet, and other data processing systems as required by the departments needs.
- Assists callers (Including policyholders, claimants, brokers, sales offices) with their inquiries and be able to explain the claim requirements across a multiple of coverage lines within established turnaround times. Refers calls to examiners as appropriate.
- Ability to identify all Lines of Business.
- Screens incoming claims for completeness of forms.
- Maintains follow- up on requests for additional information for pending claims based on department guidelines.
- Creates daily work reports on volume of documents/cover sheets for imaging.
- Enters new claims into the correct system based on the Line of Business.
- Must make sure both policy and examiner link correctly. When the policy or examiner automatically link incorrectly, they must take the appropriate steps to have it corrected.
- Updates all incoming correspondence to imaging including phone inquiry sheets.
- Prepares and batches cover sheets to claim documents for imaging.
- Reviews and verifies documents for quality and sequence.
- Must research when cover sheets and correspondence don’t match.
- Indexes and verifies each document by entering alpha or numeric fields into the imaging system as required per application for document retrieval.
- Commits documents for permanent storage on the imaging system.
- All other duties as assigned.
- High school graduate required.
- Requires one year experience in a high volume insurance/document processing environment.
- Excellent organizational skills.
- Ability to perform detailed and diversified duties including prioritization of high volume workload.
- Knowledge of personal computer to include Windows and Word.
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