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Claims Administrative Specialist

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Date: Jan 7, 2019

Location: Napa, CA, US, 94558

Company: The Doctors Management Company

    

POSITION SUMMARY:

 

Responsible for introduction and instruction to members and callers to obtain necessary written documentation to create an electronic a 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.

 

PRIMARY DUTIES AND RESPONSIBILITIES:

 

Duties Responsibilities include but not limited to:

1. Maintains a broad-based understanding of the company standards and guidelines

2. Articulates the guidelines to both internal and outside customers as necessary

3. Seeks to actively meet the expected standards and guidelines in all phases of their work product

4. Uses appropriate judgment in applying guidelines to achieve the desired outcome

5. Obtains information and necessary facts to create a claim file for the electronic claim file. Refers to designated manager for assignment and follows up.

6. Serves as first point of contact when members, administrators, agents or brokers contact TDC to report a claim file.

7. Acts as primary contact for member service within their assigned region to provide best imaginable service.

8. Generates all necessary letters for file opening, closing and in support of their assigned claim specialist(s).

9. Orders death certificates, autopsy reports, statute checks and other public records.

10. Obtains from necessary parties, signed authorizations and orders medical records.

11. Organizes medical records for the claims file and prepares records for expert review.

12. Follows-up on closed files for receipt of dismissal and settlement papers.

13. Performs various processing duties, such as updating computerized claims records, sending facsimiles, telephone support, and servicing the insured throughout the life of the claims file.

14. Completes State Reports and other forms.

15. Receives and follow up on all NPDB coding requests.

16. Prepare monthly reports for review by the Claim File Manager.

17. Maintain regional logs/lists (demands, appeal, EDR, payments, trials, DA panel etc.)

18. Run and distribute custom account loss experience reports

19. Acts as large account point person for reporting allocated and unallocated claims

20. Coordinate meetings and correspondence.

21. Processes manual payments, voids and reimbursements

22. Provides processing assistance for requests from other departments.

23. Provides assistance in maintaining medical/legal reference materials, such as articles, periodicals and manuals.

24. Manages unallocated files.

25. Manages allocated files with reserves below $30,000, which do not require field investigation. Varies by regional office

26. Performs other duties as assigned.

 

EDUCATION (AND/OR EQUIVALENT EXPERIENCE) REQUIRED:

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

 

LICENSES OR CERTIFICATIONS REQUIRED:

N/A

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: Napa

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

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