Position
Overview:
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
Classification: Non-Exempt
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 afast-pace, 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:
Education/Experience
Requirements:
- High school diploma or
equivalency
- Three
years veterinary medical experience or equivalency preferred