Claims Assistant I

Description

Job Title: Claims Assistant I

FLSA Status: Exempt

Department: Claims Management 

Reports To: Director of Claims Administration 

Position Overview:

As a Claims Assistant I for a Third-Party Administrator (TPA), you will provide administrative and clerical support to the claims department. This role involves assisting in the processing, evaluation, and documentation of insurance claims, ensuring that claims are handled efficiently and in compliance with relevant policies. You will work closely with claims adjusters, managers, clients, and claimants to ensure that claims are processed accurately and timely.

Job Responsibilities:

• Assist with intake and processing claims, including gathering and reviewing documentation.
• Input and update claims data into the claims management system.
• Organize and maintain claims files
• Communicate with policyholders, claimants, and other stakeholders 
• Answer inquiries, provide explanation of claim processes, assist in resolving issues.
• Generate claims reports for client and management review.
• Maintain claims files to ensure documents are stored in accordance with company policies.
• Provide general administrative support to the claims team.
• Annual 16 hours approved education 

Education and Work Experience:

• Associate degree or equivalent experience in insurance or claims preferred.
• Experience in insurance claims processing or a related field with customer service is preferred. 
• Experience with claims management software or other industry-specific tools is preferred.

Knowledge Skills and Abilities:

• Detail-oriented with the ability to effectively handle multiple tasks.
• Excellent written and verbal communication skills.
• Proficient in Microsoft Office Suite (Word, Excel, Outlook). 
• Strong organizational and time-management skills in a fast-paced environment.
• Ability to analyze situations, identify issues, and provide solutions when necessary.

Typical Physical Demands:

• Requires the ability to sit or stand for long periods of time, occasional stooping, and reaching; May require lifting-up to 25 pounds; requires normal range of vision and hearing with or without accommodations.

Employee Signature: ­­­­___________________ Date: ___________________

NOTE: This job description is not intended to be all-inclusive. Employee may perform other related duties as negotiated to meet the ongoing needs of the organization.