Claims Support Specialist - California & Enterprise

Blue Cross Blue Shield of Michigan; Lansing (MI); On-site; USD 42,000 - 62,000; Full time

Job summary

AF Group is seeking a Claims Customer Service Representative to support the enterprise claims teams, handling inquiries from policyholders and professionals across multiple jurisdictions. You will process documents, update systems, and provide back-up to intake and processing teams.

The role requires strong communication, organization, and multitasking abilities, with experience in insurance claims and independent problem solving. Office-based position with standard business hours.

Qualifications

• High school diploma or GED required; associate degree preferred.
• Minimum 1 year experience with AF Group as a Claims Customer Service Representative.
• Minimum 3 years general office experience; prior experience handling inquiries via phone.

Responsibilities

• Supports the customer service work and processes for Enterprise claims teams.
• Answers claim inquiries from policyholders, agents, injuried workers, attorneys, pharmacies, providers for multiple jurisdictions.
• Performs all facets of IMEs, AMEs, DDEs, QMEs as needed for claims.
• Provides backup to Claims Document Analysts for review and routing of documents.
• Reviews documents and updates keywords and data fields in the claim system.
• Re-indexes and routes documents correctly within claims.
• Downloads electronic medical records from vendors.
• Assists with resolution of FROI errors.
• Adds legal matters to the claim system.
• Reviews and routes unidentified claims mail for all brands.
• Produces forms, memos, reports, letters as requested.
• Provides copies of first reports of injuries to stakeholders.
• Updates claim system when changes occur.
• Backups intake for multi-state claims processing.
• Assigns service requests to vendors via vendor portal.
• Communicates with state WC divisions on issues.
• May train team members.

Skills

Customer service

Telephone etiquette

Communication skills

Organizational skills

Attention to detail

Multi-tasking

Data entry

Independent thinking

Research across systems

Education

High School Diploma or GED

Associate’s degree in insurance or related field

Tools

ACD telephone system

Vendor portal

Claims systems

Document management system

Spreadsheets

Word processing

Job description

AF Group is seeking a Claims Customer Service Representative to support the enterprise claims teams, handling inquiries from policyholders and professionals across multiple jurisdictions. You will process documents, update systems, and provide back-up to intake and processing teams.

The role requires strong communication, organization, and multitasking abilities, with experience in insurance claims and independent problem solving. Office-based position with standard business hours.