Claim Manager Assistant I (Remote)
Permanent - Full Time $18.50 - $19.75 / hourJob Overview
Our Story
Imagine being part of a team that’s not just shaping the future but actively driving it. At Davies North America, we’re at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors.
What's in Store
We are on the lookout for a Claim Manager Assistant I who will be responsible for handling and processing a variety of incoming and outgoing communications in a fast-paced office environment facilitating timely and accurate claim determinations. This includes handling inbound and outbound telephonic, electronic, and mail information supporting the fulfillment of claim requirements from Insureds, physicians, and care providers. The CMA I is responsible for providing superior telephonic customer service to insureds and their representatives, as well as administrative support to Claim Managers.
Key Responsibilities
1) Provide exceptional internal and external Customer Support in a phone support role
- Assist insureds, their representatives, and healthcare providers by supporting the processing of highly individualized claim inquiries
- Professionally and appropriately respond and/or forward inquiries by reviewing the established standards and guidelines
- Ensure smooth transition of claim while monitoring aging of assigned tasks meeting turnaround time standards
- Identify and respond to needs of inbound and outbound callers utilizing active listening skills; professionally and appropriately
2) Prepare claims for Claim Manager review and adjudication
- Process and document the daily administrative activities associated with claim notifications including pending, open, and closed claims, utilizing multiple tabs/screens working within a centralized work que
- Responsible for input of accurate and detailed data and notes consistently meeting established standards
- May perform additional duties and/or assist with special projects as required
3) File management and organization
- Maintain electronic file management and organization of incoming and outgoing mail including imaging, indexing, classification of documents, file management, etc.
- Critically review all documentation for completeness, credibility, consistency, and order
- Ability to recognize possible process deficiencies and suggest viable solutions
4) Meet or exceed all established minimum expectations/metrics and goals for the position
- Meet or exceed standards for productivity and quality as established for the role
- Appropriately process all confidential information abiding by HIPAA privacy laws
- Ensure smooth transition of inquiry to appropriate department if/when necessary
5) May perform additional duties as assigned
This is a full-time remote role.
This is a full-time remote role.
Skills, knowledge & expertise
- High school degree or equivalent experience required; business experience preferred
- Prior customer service experience required; insurance or medical background preferred
- Excellent organizational skills with an eye for detail
- Understanding of medical terminology a plus
- Proven interpersonal, verbal, telephonic, and written communication skills
- Must possess a high degree of tact, diplomacy and professionalism when dealing with all types of customers
- Ability to prioritize work using organizational and decision-making skills
- Must be detail oriented with ability to work independently as well as be part of a team
- Solid knowledge of Microsoft Office Products as well as other business-related software
- Ability to learn new system applications quickly
- Ability to quickly apply learned principles to specific and unique circumstances