Job Description

Claims Processor Customer Service:

• Serves customers by determining insurance coverage;
• examining and resolving claims issues;
• documenting actions;
• maintaining quality customer services;
• ensuring legal compliance.

Duties:

• Determines covered benefits by studying provisions of policy or certificate.
• Establishes proof by studying documentation;
• assembling additional information as required from outside sources, including claimant, physician, employer, and other insurance companies
• Process claims by approving or denying documentation;
• calculating benefit due; initiating payment or composing denial letter.
• Ensures compliance by following company policies, procedures, guidelines, as well as state and federal insurance regulations.
• Maintains quality customer services by following customer service practices; responding to customer inquiries.
• Protects operations by keeping claims information confidential.
• Prepares reports by collecting, analyzing, and summarizing information.
• Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
• Accomplishes organization goals by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.

Skills/Qualifications:

• Claims Experience
• Documentation Skills
• Data Entry Skills
• Analyzing Information
• Problem Solving
• Verbal Communication
• Customer Focus
• General Math Skills
• Proficient with Microsoft Office applications (Word Excel, Outlook, PowerPoint )

Contact Rob with resume. rob@comtoninc.com