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Claims Services Rep I

Company: Society Insurance
Location: Fond Du Lac
Posted on: November 28, 2019

Job Description:

Primary Purpose Supports PAL and/or WC Claims departments with management guidance by creating new claims; issuing, posting, and voiding checks; providing and maintaining information on all lines of business in accordance with departmental and company guidelines and standards. Essential Functions and Responsibilities (Other duties may be assigned) · Initiates new claims by verifying coverages; entering information into HomePage and PCA; requesting appropriate reports or estimates from various sources; distributing claims to appropriate staff member. · Assists in managing check payment process by posting field and manual drafts in PCA and HomePage; voiding drafts; issuing stop payments, loss, and expense checks; sending checks via certified mail. · Ensures customer service by answering general questions on the phone; monitoring call center message center; routing appropriate messages to proper staff members; placing outgoing phone calls to answer service questions. · Maintains databases' accuracy by entering new and updated claims information, Tax ID numbers, referrals, and mailing addresses; ISO Indexing databases. · Produces and manages information by generating, copying, indexing, printing, transmitting, and distributing letters, forms, files, reports, EDI (Electronic Data Imaging) data, and other pertinent documentation for claims files to and/or for appropriate contact. · Maintains department files by adjusting reserves; changing follow-up dates; reassigning, closing, and organizing files in accordance with department guidelines and procedures. · Produces information by requesting, generating, formatting, inputting, editing, retrieving, copying, transmitting, and distributing letters, forms, files, police reports, memos, and other pertinent documentation for claims files to and/or for appropriate staff members. · Maintains appropriate databases by entering medical, medical provider, police and/or fire department, plaintiff and defense attorney, federal identification numbers, and adjuster information. · Maintains claims-handling process by researching appropriate Underwriting file in order to verify and clarify coverage. · Assists in identifying continuous improvement opportunities and working with Senior Claims Services Representatives and the Claims Services Manager to implement any changes. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Required: · High school diploma or equivalent. · Previous customer-service experience. · Basic math skills. · Experience with the Microsoft Office suite. · Data entry skills/experience with the ability to type at least 6,000 keystrokes per hour. · Experience with operating typical office machines (such as a copy machine, printer/scanner, and computer). Preferred: · Associate's degree. · Computer software knowledge. · 1 year of experience performing hands-on support for insurance claims such as processing new claims; managing check payments; providing customer service on the phone; etc. · A record of continuing education. · Valid driver's license and a satisfactory driving record (based on Society Insurance guidelines). Supervisory Responsibilities · None. Working Conditions and Environment · Work is performed at the corporate location, with an office setting, indoor and climate-controlled. · At times, travel may be required throughout the states that Society performs business in to attend seminars. · Fast-paced work environment, requiring speed and accuracy. Physical Demands · Occasional lifting occurs (up to 30 lbs.). · Requires sitting for long periods of time. · Requires hearing to perceive the nature of sounds accurately. Must receive detailed information through oral communication over the phone. Key Competencies · Approachability · Dealing with Ambiguity · Customer Focus · Interpersonal Savvy · Listening · Organizing · Patience · Self-Development · Written Communications Society Insurance is an Equal Opportunity Employer and is committed to providing employees with a work environment free of discrimination and harassment.All employment decisions at Society are based on business needs, job requirements and individual qualifications without regard to race, color, sex, sexual orientation, gender identity, religion, national origin, age, military or veteran status, disability, genetic information or any other consideration made unlawful by applicable federal, state or local laws. Society Insurance is a drug-free workplace.Any candidate who receives an offer of employment from Society will be required to undergo a pre-employment drug test for controlled substances.All offers of employment are contingent upon successful completion of the pre-employment drug test, which is conducted in accordance with Society's substance abuse policy.PandoLogic. Keywords: Insurance Examiner, Location: Fond Du Lac, WI - 54936

Keywords: Society Insurance, Fond du Lac , Claims Services Rep I, Other , Fond Du Lac, Wisconsin

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