Claims Service Specialist

The Claims Service Specialist will support the Claims Services Managers (CSM’s) to help ensure member claim service satisfaction and provide claims service management ensuring proper communication and follow through.

ESSENTIAL EDUCATION AND EXPERIENCE: Bachelor’s Degree or equivalency in a related discipline and at least five (5) years of claim handling experience and claims customer service. Must have direct client service experience in commercial claims either through face-to-face or telephonic interactions.

SKILLS/COMPETENCIES REQUIREMENTS:

• Strong customer service orientation


• Organization, planning, and prioritization expertise with strong skills in multi-tasking and follow-up


• Works well independently and in a team environment


• Excellent written and verbal communication skills


• Comfortable in a client facing role


• Strong analytical, problem solving, judgment, and communication skills


• Willingness and ability to travel domestically at a minimal amount as required

 ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Act as a liaison between the member, broker and the claims administrator on claim and customer service matters.


• Regularly engage with clients to address questions and opportunities and ensure a transparent and supportive communication channel throughout the claims process.


• Proactively identify potential issues within claims, working diligently to resolve concerns and prevent escalations.


• Collaborate with internal and external teams to define and address member needs.


• Maintain accurate and organized records of activities, outlining ongoing client communication, history of escalations and opportunities. Prepare detailed reports for review and analysis.


• Coordinate member / broker calls to ensure all claim and captive related questions and concerns are addressed.


• Closely collaborate with the Claims Services Manager (CSM) and Captive Executive, when necessary to ensure a cohesive response and prioritization of the issue at hand.


• Actively meet with CSM to provide various updates and deliver a coordinated support of member’s needs.


• Backup the Claims Services Managers (CSM’s) specifically with client claim review telephonic conference calls on assigned


• Guide conference calls with service providers and clients to ensure a smooth and productive claim review takes place.


• Complete periodic claim audits to monitor service levels and compile and review results with CSM.


• Compile and distribute Large Loss Notices to captive CSMs and Captive Executives when necessary.


• Assist with new member onboarding.