Job Description

JOB TITLE: CLAIMS REPRESENTATIVE

JOB SUMMARY: This position analyzes insurance claims to determine extent of insurance carrier’s liability and settles claims with insureds in accordance with policy provisions. This position reports to a Claims Lead, Claims Supervisor or Manager of Claims.

PRINCIPAL DUTIES AND 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 claim • Correspond with insureds, physicians, agents and other appropriate parties in order to obtain proper documentation and to finalize claim • 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

REQUIRED / DESIRED KNOWLEDGE, EXPERIENCES AND SKILLS:

• Previous customer service experience is preferred • 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 • Bilingual English/Spanish language fluency – verbal, reading, and writing skills, a plus

EDUCATION/CERTIFICATIONS:

• High School Diploma or equivalent required; Bachelor's degree (B.A.) from an accredited institution preferred

PHYSICAL WORKING ENVIRONMENT:

While performing the duties of this job, the employee is required to stand; walk; sit for long periods of time; use of hands to grasp, handle, or feel; reach with hands and arms; finger dexterity; talk; hear. The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.

The above statements are intended to describe the general nature of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties and skills required of employees so classified.

GMMI is an Equal Opportunity Employer M/F/Disability/Veteran