Claims Specialist

Envision Healthcare•Nashville, TN

About The Position

The Specialist Claims provides support for the claims and insurance teams through appropriate reporting of medical malpractice and non-medical malpractice events as well as risk management notifications. The Claims Intake Specialist operates under the supervision of the Senior Director of Claims and is an integral part of the Insurance and Claims Team. This individual will communicate with and support our providers at all levels of the claims process. Company Overview: Envision Healthcare is a leading national medical group focused on delivering high-quality care to patients when and where they need it most. You’ll find clinicians and clinical support professionals across the nation who are proud to call Envision home. We welcome teammates of every background and work in communities that reflect the racial, ethnic, gender, sexual orientation, and economic diversity of our country.

Requirements

Well-developed written and communication skills, ability to establish relationships and communicate with providers, leadership and carriers in a professional manner.
Proficiency in Microsoft Office Suite
Ability to recognize and define problems, collect data, establish facts, draw valid conclusions and correct errors
Strong organizational habits and follow through.
High School Degree or GED required.
Minimum 1 year of previous work experience is required.

Nice To Haves

Property and Casualty Claims or Insurance experience preferred
Clinical, healthcare, claims and/or legal experience preferred
Origami Risk Information System experience preferred

Responsibilities

Organizes the Claims Management inbox, including incoming calls, mail, and faxes; identify, prioritize, and route requests to appropriate teams.
Coordinate and distribute claims and risk notifications to internal and external stakeholders in a timely manner.
Verifies provider insurance coverage and credentials using multiple databases and systems.
Prepares, reviews, and maintains claims reporting and assignment documentation in accordance with established guidelines.
Maintains accurate internal and external claims files, ensuring documentation is complete, compliant, and up to date.
Performs monthly reviews of submitted claims to ensure accuracy and completeness.
Assists with insurance coverage verifications and invoice-related check requests.
Supports data collection and reporting efforts related to claims mitigation goals and departmental metrics.
Establishes, maintains, and updates files, databases, records, reports, SOPs, templates, and documentation libraries.
Collaborates with internal teams and external vendors to support claims operations.
Escalates complex, sensitive, or non-routine issues promptly to appropriate stakeholders.
Other duties as assigned.