SUMMARY

The Claims Assistant shall be responsible for a variety of support functions for Claims Operations, which includes, but is not limited to, handling the intake of Aggregate Accommodation Requests/Claim Submissions, updating the claim systems related to the receipt of high-dollar claim notifications and monthly reports received from Third Party Administrators ("TPAs") and/or Policyholders, preparing Aggregate Claim files for the Claims Staff, assisting with the Aggregate Claim Reconciliation Process when Stop Loss Policies are completed by pursuing the needed documentation from the TPAs/Policyholders, and performing other assorted tasks/responsibilities, as assigned.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Perform Claim Intake Process, which includes, but is not limited to:

  • Creating a new claim folder in our shared file system.

  • Uploading the claim documentation into the new claim folder.

  • Setting up a new claim record in the claims system.

  • Cross reference any duplicate filings and coordinate with the Claim Specialists in relation to closing the previous filing.

• Retrieve all Monthly Aggregate Reports from the TPAs and input them into the system.

• Add all High-Dollar Trigger Notifications into the applicable shared file and claims system, and then consult with Claims Management to determine if further action is needed.

• Add Plan Documents ("PDs"), Summary Plan Descriptions ("SPDs"), and Stop Loss Policies into the corresponding claim folders, as well as send requests to Account Executives to pursue missing PDs/SPDs.

• As needed, follow up with TPAs and Policyholders to check status of requests for information and documentation in pended claim scenarios.

• Assist with the Aggregate Claim Reconciliation Process, by pursuing needed information/documentation.

• Support Claims Team when directed by Claims Management (i.e., other duties, as assigned).

Qualifications for the Claims Assistant include:

• Requires a high school diploma or equivalent. Bachelor's Degree is a plus.

• Claims and/or data entry experience preferred.

• Strong analytical abilities, excellent verbal and written communication skills, sound organizational capabilities, and effective customer service skills are a must.

• Highly proficient in Microsoft Office applications, especially Outlook, Excel, and Word.

• Must have the ability to work effectively on a team, as well as work well independently.

• Must be able to work in a fast-paced environment and maintain acceptable productivity, while maintaining a high level of quality.