Customer Service Claims

Portland, ME 04101

Posted: 06/15/2022 Employment Type: DirectHire Pay Rate: $20 to $24 hourly

Job Description

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Under the general direction of the Claims Services Manager, provides clerical and technical support to the Claims Department.  This position has no supervisory responsibilities.

 

DETAILED RESPONSIBILITIES

 

  • Process and distribute mail and fax correspondence for the Claims Department.
  • Daily filing of correspondence to ensure updated claim files.
  • Management of medical records files to include setting up, filing, copying, scanning, saving, sending and destroying.
  • Answer and/or retrieve messages from the call pool
  • Type and transcribe internal file memos, outgoing correspondence, and recorded statements as well as providing back-up assistance with transcribing Claims Committee meeting minutes when necessary.
  • Provide back-up assistance for departmental clerical responsibilities.
  • Compose routine and topic-specific correspondence as requested by the Claim Representative.
  • Accept new claim calls from physicians and institutional insureds, record basic pertinent data for follow-up by Claim Rep.
  • Schedule appointments and maintain calendar for Claim Representatives.
  • Develop familiarity with and maintain assigned claim files. Diary items for follow-up.
  • Set up and/or enter new claim files for all lines of business, to include:
  • review and confirmation of physician coverage on all new claim reports
  • fill in all data fields upon receipt of all pertinent data
  • completion of mandatory reporting documents internally/externally
  • Prepare and process all indemnifications reportable via on-line to NPDB.
  • Process file closures.
  • Process summary updates for Claims Committee packet and aid with its completion.
  • Aid with processing Claims Department invoices for payment and complete data entry of same into AP system.
  • Process all work requests as submitted by Claim Reps to include verifying of authorization when necessary for reserve changes.
  • Aid with processing CMS data on applicable files which includes gathering of pertinent data and entry of data into Oasis.
  • Manage the input of data into Oasis with regard to Attorney Firm and Attorney case handling in order to provide accurate data for the Attorney Assignment Reports.
  • Maintain the on-line Claims Oasis Training Manual.
  • Interact in a courteous and friendly manner with all MMIC employees, policyholders, and outside vendors; establish positive relationships.
  • Perform any other assigned projects, tasks or activities to enhance the overall operations of Medical Mutual Insurance Company of Maine.

 

 

 

 

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