Claims Specialist

Job Post Index 20015A-Sy##
Location Garden City, NY
Description: Description
  • Sets adequate reserves to ensure proper reporting.
  • Compares data on claim form with insurance plan to ascertain completeness and validity of the claim.
  • Examines claim form and other records to determine insurance coverage.
  • Pro-actively 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.
  • Liaison with Marketing/Customer Service departments.
  • Cultivates relationships.
  • Incrementally increase productivity without jeopardizing quality.
  • Approves claims at the appropriately demonstrated assigned authority level.
  • Functions as a resource for examiners and assist with training new examiners and customer service representative.
  • Handles difficult phone calls and composes special correspondence
Skills: Qualifications
  • 1 – 3 years Claims Adjudication experience
  • Writes clearly, concisely and effectively.
  • Communicates verbally effectively and with impact.
  • Computer literate.
  • Detail oriented
  • Ability to multi-task and mange time effectively
  • High School or GED required.
  • College preferred, or equivalent work experience
  • Committed to superior customer servicing.
  • Ability to work independently, a self-starter
  • Ability to absorb new information
  • Able to make decisions

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