Review and process all claim types as per organizational business unit.
Process claims complying with policy provisions and standards set forth in Quality Assurance guidelines.
Respond to calls, letters and emails from policyholders, agents, vendors and providers.
Chair ownership of customer issues and ensure problems are resolved promptly and professionally.
Maintain working knowledge of all company products and services pertaining to business segment.
Perform within company regulations regarding HIPAA, fraud, confidentiality and private health information.
Respond to inquiries from policyholder’s, providers, provider reps and internal partners related to claim payments, denials or explanation of benefits.
Process claim benefits as per policy benefits after accurate interpretation of policy provisions.
Determine potential coverage and develop collection strategies by reviewing claim files.
Initiate apt verbal and written communication for ultimate recovery within 90 days.
Collect and anlyze police reports, repair estimates and other related documents.
Update and maintain accurate account of collections activity and incoming payments on claim files.
Establish settlement strategy by interpreting facts of loss in relation with debtor feedback.
Guide and direct claims staff to obtain any additional investigation or information necessary to identify subrogation.
Provide subrogation training to claims offices.