Claims Support (Hybrid)

NYCM Insurance•Edmeston, NY

15d•Hybrid

About The Position

Claims Support's responsibility is to provide a supporting role for the Auto, Casualty and Property Claims divisions. Accuracy and timeliness of Support assignments have a direct impact on the claim experience and compliance with numerous insurance regulations. Duties & Responsibilities: Filing Distribution (forms, letters, checks, reports). Printing as necessary from eDocs and websites. Dictation/Maintain Transcript Log. Contents Loss Inventory spreadsheet. Assist appraisers and adjusters. Document Medicare file reviews and reporting information. Generate simple payments (adjusting, tow bills, med bills, SALVB & SALVBC, etc.). Obtain claim check copies. Limited uses of databases (such as Reg83). Set up claim (PACE). Process CD requests and Microfilm requests. Enter draft payments to claim file. Rename/re-index docs. Process police report requests and update claim file upon return. Deposit salvage/Review subro and salvage, tow, and glass checks. Complete claims processes and transactions involving confidential and sensitive information. Responsible for all reinsurance support tasks. Review/process stale dated drafts/checks. Maintain DB on PACE, such as Providers. Process all tax levies. Research and process approved appraisal payments. Liability file set up. Loss set up AS400/coding. Complex PACE updates (DOL change, etc.). Access financial institutions (Stop pay). Moderate/Advanced database usage. Process more complex financial transactions, such as ROL and ROA. Issue any/all liability/subro payments. Process incoming mail/Process return mail. Mailing all forms, letters, checks and transcriptions. Maintain knowledge of Medicare reporting laws. Determine reportable injured parties through Medicare maintenance queues and provided reports. Pend medical bills, as needed, for further contact as necessary to obtain information. Research and correct any errors identified after the quarterly Medicare submissions are returned. Report BI settlements on all Medicare eligible claims. Meet monthly and quarterly filing requirements. Research problem mail. Review/analyze reports (Loss04, Loss25, Loss20 etc.). Review claim files, reports, and medical bills to obtain reportable details. Recheck claim file reports and forms as well as contact injured parties by letter and/or telephone to obtain missing or incorrect information. Perform ISO decision net search for social security numbers and/or date of birth.

Requirements

High School Diploma
Understand the Medicare maintenance queues, actuate reports, and reports provided by analytics to aid in determining reportable injured parties
Knowledge of CPT, ICD9 & ICD10 medical codes
Good keyboarding and computer skills
Ability to work within a team
Attention to detail
Ability to follow established processes and instructions
Appropriate claim file documentation
Phone skills
Ability to multitask and prioritize
Effectively communicate and work with all Claims divisions as applicable

Responsibilities

Filing Distribution (forms, letters, checks, reports)
Printing as necessary from eDocs and websites
Dictation/Maintain Transcript Log
Contents Loss Inventory spreadsheet
Assist appraisers and adjusters
Document Medicare file reviews and reporting information
Generate simple payments (adjusting, tow bills, med bills, SALVB & SALVBC, etc.)
Obtain claim check copies
Limited uses of databases (such as Reg83)
Set up claim (PACE)
Process CD requests and Microfilm requests
Enter draft payments to claim file
Rename/re-index docs
Process police report requests and update claim file upon return
Deposit salvage/Review subro and salvage, tow, and glass checks
Complete claims processes and transactions involving confidential and sensitive information
Responsible for all reinsurance support tasks
Review/process stale dated drafts/checks
Maintain DB on PACE, such as Providers
Process all tax levies
Research and process approved appraisal payments
Liability file set up
Loss set up AS400/coding
Complex PACE updates (DOL change, etc.)
Access financial institutions (Stop pay)
Moderate/Advanced database usage
Process more complex financial transactions, such as ROL and ROA
Issue any/all liability/subro payments
Process incoming mail/Process return mail
Mailing all forms, letters, checks and transcriptions
Maintain knowledge of Medicare reporting laws
Determine reportable injured parties through Medicare maintenance queues and provided reports
Pend medical bills, as needed, for further contact as necessary to obtain information
Research and correct any errors identified after the quarterly Medicare submissions are returned
Report BI settlements on all Medicare eligible claims
Meet monthly and quarterly filing requirements
Research problem mail
Review/analyze reports (Loss04, Loss25, Loss20 etc.)
Review claim files, reports, and medical bills to obtain reportable details
Recheck claim file reports and forms as well as contact injured parties by letter and/or telephone to obtain missing or incorrect information
Perform ISO decision net search for social security numbers and/or date of birth