Essential Job Duties and Responsibilities:
- Performs claims auditing functions, including but not limited to:
- Opening claims, assigning claim numbers, entering claims data into computer, etc. in a timely manner.
- Checking losses to ensure that all supporting documentation is included and auditing claims according to established guidelines.
- Entering loss information on computer system.
- Confirming accuracy of information against error listings and corrects errors.
- Referring problem files to appropriate supervisor or manager.
- Answer questions from adjusters, agents, field staff, and insures about claim status and procedures.
- Generating and distributing various reports, such as claim forms, claim progress reports, and loss drafts.
- Performs various quality control functions, including but not limited to:
- Generating quality control documents, reports and distributing as directed.
- Entering completed quality control reviews on computer system.
- Informing appropriate staff of the review process and results.
- Making changes in policies as necessary to reflect QC audit results.
- Maintaining records of agent and adjuster training hours as necessary.
- Assist with other duties as necessary.
Knowledge, Skills, and Abilities:
- Ability to learn and apply detailed information about the Company’s products, services, processes and systems.
- Ability to organize and prioritize multiple tasks.
- Ability to work in a team oriented environment.
- Ability to effectively communicate and maintain business relationships with Company personnel, outside resources and customers.
- Ability to comprehend agents’ questions and concerns with regard to claims and to provide correct, courteous answers.
- Ability to learn and use the company’s terminology, procedures and systems.
- Ability to learn and develop skills in the use of department equipment.
- Ability to perform basic and complex mathematical calculations.
- Ability to remain calm and professional during peak periods of activity.
- Ability to work from oral and written communication.
- Ability to maintain confidentiality.
- Ability to assist in other work-related areas as required.
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