Claims Coordinator/Adjuster

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:

• Vet Tech License

Education/Experience Requirements:

• High school diploma or equivalency
• Three years veterinary medical experience or equivalency preferred