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Senior Claims Representative

Melville, NY

Posted: 12/07/2018 Employment Type: Full Time Industry: Insurance Job Number: A Pay Rate: $65,000 to $85,000 /year

Our client is a highly reputable, professional services industry leader providing medical cost containment services. We're seeking a candidate who has a strong insurance claims backgroundeither in New York No Fault, Workers Comp or Bodily Injury. A primary responsibility of this role will be quality assuring/proofing medical reports from doctors.

Additional responsibilities include:

  • Read Liability IME reports (summaries of and opinions based on medical office visit notes, physical exams, correspondence, and evaluation of studies) and review for accuracy of data, clarity, and thoroughness, to ensure the expression of a definitive and medically sound opinion while adhering to client’s protocols within a HIPAA compliant setting
  • Review Liability IME and medical record review reports to ensure the reviewer examined all body parts and strictly adhering to the Bill of Particulars Form.
  • Ensure physician reviewed all pertinent medical records assigned at the time of appointment and are commented on within the report accordingly.
  • Ensure all reports are delivered timely in accordance with the applicable State laws and regulations.
  • Process addendums as requested by clients in a timely manner.
  • Ensure all practices are carried out in accordance with HIPPA compliance practices, state and federal safety standards and legal regulations.
  • Promote effective and efficient utilization of clinical resources and supplies.
  • Communicate via a secured phone, email or fax with doctors, doctor’s staff or adjusters for needed updates/clarifications or revision/corrections to the report or addendum.
  • Enter update/notes in the Support Claim Services (SCS) system which reflects the processing and outcome of the reports/addendums for billing and scanning purposes and to reflect a timely turn around.
  • Coordinate scanning efforts with the IT Department to ensure client(s) receives completed reports in a timely manner.
  • When necessary, notifies management of any report issues or concerns requiring managements’ attention.

 

Qualifications:

  • Experienced in the insurance industry, preferably with a Claims Representative background
  • Knowledge of medical reports preferred
  • Strong proofing, editing, or reviewing skills with a strong attention to detail
  • Ability to prioritize tasks, follow through on projects and tasks to completion
  • Strong technical and communication skills

David Lutz
Recruiter

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