Claims Examiner

Fortegra•Jacksonville, FL

8d•Onsite

About The Position

Primarily responsible for providing exceptional customer service to our clients. Take incoming calls using our Web Warranty/Web Claim program. Review claims for approvals, distribution of authorizations or sending of denial letters. Helps to enforce contractual requirements impartially and expeditiously. Adjudicate, investigate and/or deny claims by verifying submitted information, coverage issued, and other pertinent information. Identify claims of a potentially fraudulent nature and refer to management for review. Monitor and process claims to meet the demands of a production environment and to adhere to established service standards. Process claims via our phone and portal systems using Web Warranty/Web Claims program. Handle customer service questions or transfer call to appropriate numbers. Adjudicate claims based off the terms and conditions of the service contract. Follow-up with Service Providers and Technicians for required claims information. Complete Claim Administration functions. Handle ESC Resend Requests. When required, may send cleaning products to customers. Participate in any projects, reports, documentation, tasks or objectives assigned. The above cited duties and responsibilities describe the general nature and level of work performed by people assigned to the job. They are not intended to be an exhaustive list of all the duties and responsibilities that an incumbent may be expected or asked to perform.

Requirements

High School Diploma or equivalency required.
2 or more years experience with claims and/or other related claims processes is required.
Demonstrate exceptional customer service skills and stellar telephone etiquette with professional dictation and written communication skills.
Strong e-mail and internet skills
Ability to analyze/resolve problems and adapt to change.
MS Office Suite, including word, excel and access (typing min 50 wpm).
Must be able to multi-task (computer, phone, and documents/reference manuals).

Nice To Haves

1-2 years of customer service experience preferred.
Bilingual (Spanish/English) highly preferred.

Responsibilities

Provide customer service to clients.
Take incoming calls using Web Warranty/Web Claim program.
Review claims for approvals, distribution of authorizations or sending of denial letters.
Enforce contractual requirements impartially and expeditiously.
Adjudicate, investigate and/or deny claims by verifying submitted information, coverage issued, and other pertinent information.
Identify potentially fraudulent claims and refer to management.
Monitor and process claims to meet production demands and service standards.
Process claims via phone and portal systems using Web Warranty/Web Claims program.
Handle customer service questions or transfer calls.
Adjudicate claims based off the terms and conditions of the service contract.
Follow-up with Service Providers and Technicians for required claims information.
Complete Claim Administration functions.
Handle ESC Resend Requests.
Send cleaning products to customers when required.
Participate in projects, reports, documentation, tasks or objectives assigned.