Claims Representative

Generali Global Assistance•Pembroke Pines, FL

9d•Hybrid

About The Position

Why work with us? The North American branch of Generali Global Assistance offers a diverse and inclusive work environment while employees work towards making real difference in the lives of our clients. As an Organization, we pride ourselves with offering white glove service while being mindful of corporate responsibility and our environmental footprint. Employees enjoy a plethora of benefits to include: A diverse, inclusive, professional work environment Flexible work schedules Company match on 401(k) Competitive Paid Time Off policy Generous Employer contribution for health, dental and vision insurance Company paid short term and long term disability insurance Paid Maternity and Paternity Leave Tuition reimbursement Company paid life insurance Employee Assistance program Wellness programs Fun employee and company events Discounts on travel insurance Who are we? Generali Global Assistance is proudly part of the Europ Assistance Group brand and our products utilize a number of corporate and product brands. The brands for our North American team include the following: CSA: US travel insurance brand for retail and lodging partners. Learn more here . Generali Global Assistance (GGA): The primary Corporate brand in the United States for our travel insurance, travel assistance, identity and cyber protection, and beneficiary companion products. Learn more here . GMMI: the industry standard for global medical cost containment and medical risk management solutions. Learn more here . Iris, Powered by Generali: identity and digital protection solution. Learn more here . Trip Mate: US travel insurance brand for tour operator, cruise and airline partners. Learn more here . What youll be doing. Job Summary: This position is responsible for analyzing and processing insurance claims to determine the extent of the insurance carriers liability in a manner that supports the mission, values, and standards of the Company. Primary responsibilities include efficient adjudication of insurance claims, both phone and written communication with insureds, travel suppliers, medical facilities, and others, as well as maintaining all state Department of Insurance regulations for claims files. Weekends may be required. This position reports to the Claims Supervisor.

Requirements

Exceptional communication, problem-solving, and organizational skills.
Strong reading, writing, comprehension, and proofreading skills.
Knowledge of standard concepts, practices, regulations, and laws within insurance field preferred.
Previous claims and customer service experience are highly preferred.
High School Diploma or Equivalent (GED) required.

Nice To Haves

Bilingual English/Spanish language fluency verbal, reading, and writing skills, is a plus.

Responsibilities

Process all claims assigned in a timely, efficient, and accurate manner ensuring that all appropriate policies, procedures, and standard best practices are being followed.
Review information on claim forms, Physician Statements, and other documentation to ascertain completeness and validity of claims.
Correspond with insureds, physicians, agents, and other appropriate parties to obtain proper documentation and to finalize claims.
Maintain proper reserves on each claim file.
Ensure that proper file documentation is collected and maintained, including all records of correspondence and telephone conversations.
Investigate claims and direct the activities of outside adjusters and investigators.
Issue denial of benefits letters when appropriate.
Process attorney represented claims files.
Review and respond to Department of Insurance complaint letters.
Respond to written and phone inquiries regarding claims status.
Issue payments in a timely and accurate manner.
Ensure that current Federal and State insurance claims regulations, laws, and best practices are being employed consistently for all jurisdictions.
Answer questions and respond to inquiries from internal and external customers regarding coverage issues and general policy information.
Assist in the mentoring and training of other employees as directed.
Perform other duties or special projects as assigned by the management team.