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Claims Administrative Specialist

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Date: Jun 5, 2019

Location: Lake Oswego, OR, US

Company: The Doctors Management Company

    

 

The Doctors Company is seeking an experienced Claims Administrative Specialist to support our Northwest Region team.

 

Responsible for introduction and instruction to members and callers to obtain necessary written documentation to create an electronic claim file. Also provides clerical and technical assistance to the assigned claims staff. Maintains specific, timely, accurate coding and file updates to support data warehouse searches for claims processing and TDC research projects. The position’s contacts are employees, member physicians, agents, brokers vendors, defense lawyers, administrators and patients. This position works under immediate supervision.

 

Qualifications

 

  • Bachelor’s degree or equivalent combination of education and experience required.

 

Internal/ External Customer Collaboration & Support

 

  • Interfaces with insured members in a professional manner necessary to achieve the best possible outcome.
  • Professionally engages both internal and external customers when necessary without prompting.
  • Uses internal resources to assist with problem-solving.

 

 

Member Service       

 

  • Provides clear communication to members and follows up as necessary based on expectations agreed to with the member.
  • Maintains awareness of member's needs and context of their communication in order to provide proper support.
  • Elevates concerns expressed by the insured member to management as necessary.
  • Provides excellent service to regional team members who submit requests to the team.
  • Provides high-quality, comprehensive work-product that facilitates efficient/effective downstream workflow.

 

Policy/ Procedure Development and Compliance           

  • Complies with all established policies and procedures for the service team.
  • Identifies and elevates potential areas for improvement and service enhancements.
  • Actively remedies compliance issues as identified by management.
  • Claims Guidelines (Reserve Management, File Documentation Management)
  • Maintains a broad-based understanding of the company standards and guidelines.
  • Articulates the guidelines to both internal and outside customers as necessary.
  • Seeks to actively meet the expected standards and guidelines in all phases of their work product.
  • Uses appropriate judgment in applying guidelines to achieve the desired outcome.
  • Monitors and approves fees and expenses within authority to comply with company guidelines and state statutory guidelines.
  • Evaluates attorney work product/performance and advises supervisor of any need for corrective action or improvement

 

 

Other Duties as Assigned 

 

  • Supports process improvement projects and initiatives.

 

 

Benefits

 

We offer competitive compensation, incentive bonus plans, outstanding career opportunities, an exceptional work environment, and an impressive benefits package, which starts with medical, family and bereavement leave; same-sex domestic partner benefits; short- and long-term disability programs; and an employee assistance program. There's more:

  • Health, dental, and vision insurance
  • Health and dependent care tax-free spending accounts with a company match
  • 401(k) and Roth IRA with company match, as well as catch-up plans for both
  • 10 paid vacation days, 6 paid sick days, and 6 paid personal days each calendar year (with vacation increases based on length of service)
  • 10 paid holidays each calendar year
  • Life and travel insurance
  • Tax-free commuter benefits
  • In-person and online learning opportunities
  • Cross-function career opportunities
  • Business casual work environment
  • Time off to volunteer
  • Matching donations to qualifying nonprofit organizations
  • Company-sponsored participation at non-profit events

 

Overview

 

At The Doctors Company, we are fiercely committed to our mission of advancing, protecting, and rewarding the practice of good medicine. Our employees are integral to our success as the nation’s largest physician-owned medical malpractice insurer—and reflect our core values of service and professionalism. Employees also make a difference in their communities through volunteer work and donations. In the last five years, employees have worked more than 5,000 hours for local community organizations and donated more than $500,000, in conjunction with a company matching funds program.

 

The Doctors Company is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.

 


Nearest Major Market: Portland Oregon

Job Segment: Claims, Medical, Data Warehouse, Business Process, Insurance, Healthcare, Research, Technology, Management

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