JOB PURPOSE:
The Claims Specialist is responsible for managing the day-to-day claims operations.
KEY RESPONSIBILITIES:
- Reviews all new claims and establishes a plan of action to achieve favorable claim resolution.
- Reviews claims status, action plans, and reserves consideration of client cost.
- Advocates, consults and provides coverage advice to clients as appropriate.
- Searches for new Home Care agencies, ATPs, DME companies, etc.
- Manages billing, quoting and negotiating rates with adjusters and vendors.
- Performs other related duties as assigned.
LEADERSHIP PRINCIPLES BEHAVIORS:
- Urgency – maintains a sense of urgency as needed.
- Bold – challenges the status quo when faced with obstacles while assisting customers.
- Effective listening – stays focused on the moment, clarifies and reflects.
- Compassionate – shows understanding and concern for others.
- Clear vision – forward thinking.
QUALIFICATIONS, SKILLS AND EXPERIENCE:
- Bachelor’s Degree preferred.
- Strong communication, analytical and customer service skills.
- Ability to prioritize efficiently and remain focused while handling multiple tasks
PHYSICAL REQUIREMENTS:
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Ability to meet essential functions of the position with reasonable accommodations as necessary.
- Prolonged periods of working at a desk and/or on a computer
- Ability to work overtime as needed.
Required Skills
Required Experience
Tags
full-time