Claims Processing Associate

Emergent Holdings, Inc.; Lansing (MI); On-site; USD 42,000 - 64,000; Full time

Job summary

Emergent Holdings, Inc. is seeking a claims intake specialist to maintain incoming workload, resolve issues, and process first report of injury (FROI) and first notice of injury (FNOI) submissions.

You will determine jurisdiction from multiple sources and route to the correct destination while handling priority requests and updates to existing claims. The role requires strong attention to detail, two years of office experience, and proficient communication skills.

Qualifications

• High school diploma or GED required; combination may be considered.
• Minimum of two years of general office experience, including customer service.
• Experience with document management systems and basic computer knowledge.
• Excellent verbal and written communication skills.

Responsibilities

• Identify jurisdiction, date of injury and handling items; research and re-index non-new submissions to route to appropriate handling.
• Receive incoming general new claims calls for all entities; backup for calls if telephone system shutdown.
• Make changes and updates on newly created or existing claims; guide end-users on processes.
• Serve as resource for intake-related issues; determine jurisdiction and help in finding coverage or information.
• May participate in training employees new to the role.
• Process Workers’ Compensation claims from Open Pool queues or via telephone; code body part, diagnosis and cause of injury; review for accuracy.
• Confirm policy coverage for date of injury, business location and injury location; request policy updates as needed.
• Maintain department procedures and workflows; may create new workflows.
• Research state and internal systems; route mail to appropriate region/department; forward unidentified mail with form letters.
• Route documents to medical bill review vendor.

Skills

Customer service

Communication

Data entry

Organization

Multi-tasking

Training others

Phone etiquette

Education

High school diploma or GED

Tools

Excel

Word

Document management system

Job description

JOB DESCRIPTION

This role will focus on maintenance of our incoming workload, issue resolution and first report of injury (FROI) issues. This position determines jurisdiction for entry of first notice of injury (FNOI) from multiple sources and distributes to the proper destination. Enters and supports priority and special requests, including correcting newly-created claims.

• Identifies jurisdiction, date of injury and special/additional handling items; researches and re-indexes non-new claim submissions to route to appropriate handling.
• Receives incoming general new claims calls for all entities; backup for ACD calls in the event of telephone system shutdown.
• Makes changes, corrections and updates on newly created and/or existing claims or submissions as well as guiding end-users on process techniques in various applications.
• May serve as a resource regarding intake-related issues, i.e., determine jurisdiction, assist in clearing policy issues to process claim; in finding coverage or other information.
• May participate in training employees new to the role.
• Processes Workers’ Compensation claims retrieved from Open Pool queues or via telephone; codes body part, diagnosis and cause of injury by entering submitted data in the claims system reviews claim for accuracy prior to completion and performs all tasks specified for state-specific requirements after claim setup.
• Confirms policy coverage for date of injury, business location and injury location; requests policy update for locations as needed.
• Maintains department procedures, working instructions and job aides; may participate in creating new workflows or workflow changes.
• Researches multiple state and internal systems and documents and routes/or indexes incoming mail to appropriate region and/or department from unidentified mail queue.
• Forwards unidentified mail to sender using appropriate form letters.
• Routes documents to medical bill review vendor.

Summary

This role will focus on maintenance of our incoming workload, issue resolution and first report of injury (FROI) issues. This position determines jurisdiction for entry of first notice of injury (FNOI) from multiple sources and distributes to the proper destination. Enters and supports priority and special requests, including correcting newly-created claims.

Essential Duties And Responsibilities

• Identifies jurisdiction, date of injury and special/additional handling items; researches and re-indexes non-new claim submissions to route to appropriate handling.
• Receives incoming general new claims calls for all entities; backup for ACD calls in the event of telephone system shutdown.
• Makes changes, corrections and updates on newly created and/or existing claims or submissions as well as guiding end-users on process techniques in various applications.
• May serve as a resource regarding intake-related issues, i.e., determine jurisdiction, assist in clearing policy issues to process claim; in finding coverage or other information.
• May participate in training employees new to the role.
• Processes Workers’ Compensation claims retrieved from Open Pool queues or via telephone; codes body part, diagnosis and cause of injury by entering submitted data in the claims system reviews claim for accuracy prior to completion and performs all tasks specified for state-specific requirements after claim setup.
• Confirms policy coverage for date of injury, business location and injury location; requests policy update for locations as needed.
• Maintains department procedures, working instructions and job aides; may participate in creating new workflows or workflow changes.
• Researches multiple state and internal systems and documents and routes/or indexes incoming mail to appropriate region and/or department from unidentified mail queue.
• Forwards unidentified mail to sender using appropriate form letters.
• Routes documents to medical bill review vendor.

Education And Experience

Relevant combination of education and experience may be considered in lieu of degree.

• EDUCATION REQUIRED: High school diploma or G.E.D.
• EXPERIENCE REQUIRED: Minimum of two years of general office experience, including customer service experience that provides the required skills, knowledge and abilities.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Other Skills And Abilities

• Excellent verbal and written communication skills.
• Ability to be an independent thinker to solve issues.
• Excellent organizational skills and ability to prioritize work to meet established deadlines.
• Basic knowledge of computers and spreadsheet software with data entry ability Basic knowledge of word processing software.
• Excellent customer service skills
• Knowledge of multi-functional telephone system.
• Ability to proofread correspondence for accuracy of spelling, grammar, punctuation and format.
• Ability to verify data for accuracy.
• Ability to multi-task i.e. interacts on telephone while entering data.
• Ability to work effectively with various business units.
• Ability to train and coach others to perform the core responsibilities.
• Ability to work varied hours/days/shifts.
• ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES PREFERRED:
• Insurance Institute of America (IIA) or other insurance related coursework.
• Knowledge of Workers Compensation or insurance.
• Basic knowledge of spreadsheet software.
• Knowledge of medical terminology.
• Knowledge of claims reporting process for multiple states.
• Experience using a document management system with workflows.
• Other insurance related coursework.
• Experience providing customer service over the phone.
• Excellent telephone etiquette.

Working Conditions

Work is performed in an office setting with no unusual hazards. Work may be performed at varied hours/days/shifts.

Additional Information

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. This job description does not constitute a contract for employment.