Analyzing and regulating insurance claims processes for various insurance products. Work for a leading insurance company focusing on customer service and quality assurance.
About the role
- Claims Representative responsible for processing insurance claims and ensuring compliance with regulations. Working for Generali Global Assistance and communicating with stakeholders to finalize claims.
Responsibilities
- This position is responsible for analyzing and processing insurance claims to determine the extent of the insurance carriers liability in a manner that supports the mission, values, and standards of the Company.
- Primary responsibilities include efficient adjudication of insurance claims, both phone and written communication with insureds, travel suppliers, medical facilities, and others, as well as maintaining all state Department of Insurance regulations for claims files.
- Claims Processing and Coordination: Process all claims assigned in a timely, efficient, and accurate manner ensuring that all appropriate policies, procedures, and standard best practices are being followed.
- Review information on claim forms, Physician Statements, and other documentation to ascertain completeness and validity of claims.
- Correspond with insureds, physicians, agents, and other appropriate parties to obtain proper documentation and to finalize claims.
- Maintain proper reserves on each claim file.
- Ensure that proper file documentation is collected and maintained, including all records of correspondence and telephone conversations.
- Investigate claims and direct the activities of outside adjusters and investigators.
- Issue denial of benefits letters when appropriate.
- Process attorney represented claims files.
- Review and respond to Department of Insurance complaint letters.
- Respond to written and phone inquiries regarding claims status.
- Issue payments in a timely and accurate manner.
- Ensure that current Federal and State insurance claims regulations, laws, and best practices are being employed consistently for all jurisdictions.
- Customer Service: Answer questions and respond to inquiries from internal and external customers regarding coverage issues and general policy information.
- Teamwork and Department Support: Assist in the mentoring and training of other employees as directed. Perform other duties or special projects as assigned by the management team.
Requirements
- Exceptional communication, problem-solving, and organizational skills.
- Strong reading, writing, comprehension, and proofreading skills.
- Knowledge of standard concepts, practices, regulations, and laws within insurance field preferred.
- Bilingual English/Spanish language fluency verbal, reading, and writing skills, is a plus.
- Previous claims and customer service experience are highly preferred.
- High School Diploma or Equivalent (GED) required.
Benefits
- A diverse, inclusive, professional work environment
- Flexible work schedules
- Company match on 401(k)
- Competitive Paid Time Off policy
- Generous Employer contribution for health, dental and vision insurance
- Company paid short term and long term disability insurance
- Paid Maternity and Paternity Leave
- Tuition reimbursement
- Company paid life insurance
- Employee Assistance program
- Wellness programs
- Fun employee and company events
- Discounts on travel insurance
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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