Handle calls from the Nationwide Toll-Free Service which may originate from any area within the network or from another network-this comprises of about 65% of the position.
November 17, 2022
Demonstrated ownership attitude and customer centric response to all assigned tasks - Basic Verbal and written communication skills -Intermediate Attention to detail ensuring accuracy - Basic Ability to work in a high volume, fast paced environment managing multiple priorities - Basic Analytical Thinking - Basic Judgment/ Decision Making - Basic.
December 21, 2022
Provides direct guidance and assistance to customers regarding processing procedures and explains how their inquiries will be answered if additional information is requested.
January 01, 2023
Manages, controls and negotiates timely and equitable claim payments and settlements in accordance with jurisdictional and fair claims practice requirements and company policy and procedures.
February 28, 2023
Review and research incoming healthcare claims from members and providers(doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing .
April 06, 2023
Performs timely and thorough investigations in an effort to comply with all jurisdictional requirements and/or entitlements.
April 08, 2023
Determines appropriate settlement amount based on independent judgment, computer assisted building and/or contents estimate, estimation of actual cash value and replacement value, contractor estimate validation, appraisals, application of applicable limits and deductibles and work product of Independent Adjusters.
April 10, 2023
Assist in the department's effort to continuously improve service by identifying and recommending changes or additions to current workflow, practices, processes, procedures, systems, and training.
May 10, 2023
Develops litigation plan with staff or panel counsel, including discovery and legal expenses, to assure effective resolution and to satisfy customers.
May 10, 2023
Investigates and evaluates all relevant facts to determine coverage, damages and liability of first-party property damage claims (including but not limited to analyzing leases, contracts, by-laws and other relevant documents which may have an impact), damages, business interruption calculations and liability of first-party property claims under a variety of policies.
May 15, 2023