PetFirst Pet Insurance is seeking a Claims Coordinator Adjuster. This is your opportunity to take your veterinary medical experience from a clinical setting to an office environment!
The Claims Coordinator/Adjuster accurately reviews medical records and invoices, utilizing their understanding of pet health diagnoses and procedures, to evaluate coverage and equitably settle pet health insurance claims with respect to policy limits & terms.
Communicates with the Insured, Veterinarian or Pet Adoption Agency to determine the details of the claim, requesting and verifying necessary documentation, and informs the Insured of claim status or claim outcome. Utilizes the workflow queues to perform job functions to include: claim entry/policy association, pre-adjudication, Insured/Veterinarian documentation requests, claim closeouts, claim appeals, and “good to go” claims processing.
Status: Full Time
Reports to: Claims and Risk Manager
Essential Duties and Responsibilities:
Adjudicates for allocation of deductibles, co-pays, co-insurance maximums, and provider reimbursements
Follows adjudication policies and procedures to ensure proper payment of claims
Documents phone calls in system and follows up on issues if needed
Resolves problems resulting from claim adjudication
Prepares reports as required by management
Enters/receives inbound documents as assigned
Requests and communicates with Insureds, Veterinarians, or Adoption Agencies for clarification of diagnosis/additional information necessary to accurately process claim
Communicates claim status and claim outcome with Insureds
Procures and maintains adjuster’s license in all relevant states
Meets or exceeds goals and productivity levels set by management
Will perform all other duties as assigned by management
Essential Knowledge, Skills, and Abilities:
Strong understanding of veterinary medical terminology
Ability to operate in a fast-paced, multi-tasking environment with deadlines
Strong written, verbal, interpersonal, and phone communication skills
Articulate, professional, and possesses a strong quality customer service mindset with attention to detail
Strong computer background using MS Word, Outlook, Excel, and Internet
Ability to learn quickly (to include our proprietary CRM system for managing customers)
Excellent tracking, follow-up, and relationship building skills
Ability to identify problems and logically research with minimum assistance to locate answer through appropriate reference materials
Proven history of adherence to corporate policies, procedures, and guidelines
Proven Attendance Reliability
Beneficial Knowledge, Skills, and Abilities:
Vet Tech License
High school diploma or equivalency
Three years of veterinary medical experience or equivalency preferred.