Job Description

Accentuate Staffing is currently recruiting for a hybrid Claims processor to join an established commercial insurance company in Raleigh. This role will be hybrid (2 days from home ). The Claims Processor will be responsible for cataloguing incoming electronic documents for the claims department, preparing and sending daily, weekly, monthly claims reports, as well as other duties as needed. This role will also assist with claims inbound calls with the goal of providing an exceptional customer experience.

Responsibilities:

• Adhere to the Claims Support schedule to ensure call service levels are met and customer satisfaction remains high.
• Index documents accurately and consistently attain monthly goal.
• Prepare reports and letters, completing and submitting them on time based on jurisdictional requirements.
• Initiate offsite check printing and prepare EOB’s daily.
• Respond to inbound calls from both internal and external customers and handle appropriately in a timely manner.
• Process unidentified mail, agent mailings and underwriting return envelopes to proper resolution.
• Investigate provider inquiries regarding bills and payments, providing EOBs as requested.
• Report any challenges, defects with workflows to Claims Support Supervisor
• Demonstrate proficiency with ImageRight, 8×8 and Advanced Claims.
• Issue payments for claims file expenses as directed.
• Process Entity Entry (I-9) to ensure compliance.
• Photocopying claim files, cataloguing medical records and electronic claim file data including EDI and other similar items.
• Perform data entry functions as directed by Adjusters and Claim Services Manager

Requirements:

• High school diploma or equivalent
• At least 2 years of customer service/support experience and/or two years of commercial insurance and/or claims experience or an equivalent combination of education and experience.
• PC Computer skills (MS Office, Outlook); knowledge of policy processing systems, imaging systems and/or CRM systems is a plus.
• Excellent customer relationship management skills required.
• Ability to learn quickly and adapt to changing environment.
• Solid customer focus and soft skills

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