Administrator - Insurance Operations

Company:

Description:

Reviews and understands incoming documentation and new claims notifications under supervision of more senior colleagues, informs colleagues of any potential problems or contentious claims, and seeks guidance or advice where necessary to ensure the proper processing of claims.

Identifies which policies or parts of the coverage that may be effected by incoming low complexity claims from middle-market and/or low complexity clients, seeks validation where necessary, and advice where uncertain or clarification required to ensure the proper protocol is followed.

Determines coverage for incoming claims of low complexity, of small-medium size, and/or for small-medium sized clients through use of their knowledge of the policies as well as communicating with Underwriters Insurers to help their clients manage their incoming claims and ensure that claim management processes adheres to established standards.

Escalates complex issues pertaining to claims complications and the necessity for technical knowledge to senior colleagues and to claims advocates in order to ensure proper application of pertinent claims policy and calculation of claims rates.

Liaises with advocates and/or clients to ensure the proper processing of specific claims-related issues, or client service concerns.

Communicates with clients, beneficiaries, third parties or insurers to receive status updates, common information requests, instructions or query resolution.

Generates, validates and distributes claims reports, to ensure accurate records are produced and distributed.

Facilitates collection from insurers on small claims and tracks the different parts of claims being paid for common claims settlements in order to keep orderly record of ongoing work.