Claims Processing Associate

We need to output HTML fragment with headings

for sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. We must not repeat job title. Must not include Job ID etc. Must preserve all substantive info, no invented details. Remove boilerplate. We need to parse the job description. Given text: Summary JOB DESCRIPTION This role will focus on maintenance of our incoming workload, issue resolution and first report of injury (FROI) issues. This position determines jurisdiction for entry of first notice of injury (FNOI) from multiple sources and distributes to the proper destination. Enters and supports priority and special requests, including correcting newly-created claims. Essential Duties And Responsibilities (list of duties) Education And Experience (Education Required, Experience Required) Qualifications (list of requirements) Other Skills And Abilities (list of skills) ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES PREFERRED: (list) Working Conditions (Work is performed in an office setting...) Additional Information (some generic statements) We need to map to sections: About the role (summary), Responsibilities (essential duties), Requirements (education/experience required?), Qualifications (maybe same as requirements?), Skills (other skills and abilities, plus preferred), Benefits (none), Pay (none), Schedule (maybe varied hours/days/shifts mentioned in Working Conditions and also Ability to work varied hours/days/shifts). So we can include Schedule section if there is specific content: "Ability to work varied hours/days/shifts." and "Work may be performed at varied hours/days/shifts." That's specific enough. Benefits: none mentioned. Pay: none. Thus sections: About the role, Responsibilities, Requirements, Qualifications, Skills, Schedule. We must not create empty sections. Now we need to format. Use

for each section heading. Inside each, use

for prose,

• for lists. We need to preserve all substantive info. Let's extract content. About the role: The summary paragraph: "This role will focus on maintenance of our incoming workload, issue resolution and first report of injury (FROI) issues. This position determines jurisdiction for entry of first notice of injury (FNOI) from multiple sources and distributes to the proper destination. Enters and supports priority and special requests, including correcting newly-created claims." We can put that as a

  . Responsibilities: list of duties from "Essential Duties And Responsibilities". Let's extract each bullet-like sentence. The text: "Identifies jurisdiction, date of injury and special/additional handling items; researches and re-indexes non-new claim submissions to route to appropriate handling. Receives incoming general new claims calls for all entities; backup for ACD calls in the event of telephone system shutdown. Makes changes, corrections and updates on newly created and/or existing claims or submissions as well as guiding end-users on process techniques in various applications. May serve as a resource regarding intake-related issues, i.e., determine jurisdiction, assist in clearing policy issues to process claim; in finding coverage or other information. May participate in training employees new to the role. Processes Workers’ Compensation claims retrieved from Open Pool queues or via telephone; codes body part, diagnosis and cause of injury by entering submitted data in the claims system reviews claim for accuracy prior to completion and performs all tasks specified for state-specific requirements after claim setup. Confirms policy coverage for date of injury, business location and injury location; requests policy update for locations as needed. Maintains department procedures, working instructions and job aides; may participate in creating new workflows or workflow changes. Researches multiple state and internal systems and documents and routes/or indexes incoming mail to appropriate region and/or department from unidentified mail queue. Forwards unidentified mail to sender using appropriate form letters. Routes documents to medical bill review vendor." We need to preserve all. We'll put each as

• . Requirements: Education And Experience section. "Education And Experience Relevant combination of education and experience may be considered in lieu of degree. EDUCATION REQUIRED: High school diploma or G.E.D. EXPERIENCE REQUIRED: Minimum of two years of general office experience, including customer service experience that provides the required skills, knowledge and abilities." We can put as

  maybe combine. Qualifications: The section "Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions." That's a bit generic but still substantive. Then list of requirements? Actually after that there is "Other Skills And Abilities". So Qualifications section maybe just that paragraph. We'll include as

  . Skills: "Other Skills And Abilities" list plus "ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE AND/OR ABILITIES PREFERRED:" list. Let's extract Other Skills And Abilities list: "Excellent verbal and written communication skills. Ability to be an independent thinker to solve issues. Excellent organizational skills and ability to prioritize work to meet established deadlines. Basic knowledge of computers and spreadsheet software with data entry ability Basic knowledge of word processing software. Excellent customer service skills Knowledge of multi-functional telephone system. Ability to proofread correspondence for accuracy of spelling, grammar, punctuation and format. Ability to verify data for accuracy. Ability to multi-task i.e. interacts on telephone while entering data. Ability to work effectively with various business units. Ability to train and coach others to perform the core responsibilities. Ability to work varied hours/days/shifts." Now Preferred list: "Insurance Institute of America (IIA) or other insurance related coursework. Knowledge of Workers Compensation or insurance. Basic knowledge of spreadsheet software. Knowledge of medical terminology. Knowledge of claims reporting process for multiple states. Experience using a document management system with workflows. Other insurance related coursework. Experience providing customer service over the phone. Excellent telephone etiquette." Note there is duplication: "Basic knowledge of spreadsheet software." appears also in other skills; but we keep as is. We'll combine both lists under Skills section maybe split into Required Skills and Preferred Skills? But we only have Skills heading; we can include all as a single list, but we might want to separate. However instructions: Use

  • for any list of duties/requirements/benefits. So we can make one list for Skills (including both). Could also make two lists but still under Skills heading. We'll output as
    • for each item. Schedule: from Working Conditions and Ability to work varied hours/days/shifts. Working Conditions: "Work is performed in an office setting with no unusual hazards. Work may be performed at varied hours/days/shifts." Also Ability to work varied hours/days/shifts already in skills but we can still include schedule specifics. We'll put schedule as

      combining those sentences. Now ensure we don't include boilerplate: "Additional Information The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. This job description does not constitute a contract for employment." That's generic; we should remove as per instruction: remove boilerplate. So we omit Additional Information. Also remove "Summary JOB DESCRIPTION" maybe not needed; we already have About the role. Now produce HTML fragment. Let's craft.

      About the role

      This role will focus on maintenance of our incoming workload, issue resolution and first report of injury (FROI) issues. This position determines jurisdiction for entry of first notice of injury (FNOI) from multiple sources and distributes to the proper destination. Enters and supports priority and special requests, including correcting newly-created claims.

      Responsibilities

      • Identifies jurisdiction, date of injury and special/additional handling items; researches and re-indexes non-new claim submissions to route to appropriate handling.
      • Receives incoming general new claims calls for all entities; backup for ACD calls in the event of telephone system shutdown.
      • Makes changes, corrections and updates on newly created and/or existing claims or submissions as well as guiding end-users on process techniques in various applications.
      • May serve as a resource regarding intake-related issues, i.e., determine jurisdiction, assist in clearing policy issues to process claim; in finding coverage or other information.
      • May participate in training employees new to the role.
      • Processes Workers’ Compensation claims retrieved from Open Pool queues or via telephone; codes body part, diagnosis and cause of injury by entering submitted data in the claims system reviews claim for accuracy prior to completion and performs all tasks specified for state-specific requirements after claim setup.
      • Confirms policy coverage for date of injury, business location and injury location; requests policy update for locations as needed.
      • Maintains department procedures, working instructions and job aides; may participate in creating new workflows or workflow changes.
      • Researches multiple state and internal systems and documents and routes/or indexes incoming mail to appropriate region and/or department from unidentified mail queue.
      • Forwards unidentified mail to sender using appropriate form letters.
      • Routes documents to medical bill review vendor.

      Requirements

      Education And Experience: Relevant combination of education and experience may be considered in lieu of degree. EDUCATION REQUIRED: High school diploma or G.E.D. EXPERIENCE REQUIRED: Minimum of two years of general office experience, including customer service experience that provides the required skills, knowledge and abilities.

      Qualifications

      To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

      Skills

      • Excellent verbal and written communication skills.
      • Ability to be an independent thinker to solve issues.
      • Excellent organizational skills and ability to prioritize work to meet established deadlines.
      • Basic knowledge of computers and spreadsheet software with data entry ability
      • Basic knowledge of word processing software.
      • Excellent customer service skills
      • Knowledge of multi-functional telephone system.
      • Ability to proofread correspondence for accuracy of spelling, grammar, punctuation and format.
      • Ability to verify data for accuracy.
      • Ability to multi-task i.e. interacts on telephone while entering data.
      • Ability to work effectively with various business units.
      • Ability to train and coach others to perform the core responsibilities.
      • Ability to work varied hours/days/shifts.
      • Insurance Institute of America (IIA) or other insurance related coursework.
      • Knowledge of Workers Compensation or insurance.
      • Basic knowledge of spreadsheet software.
      • Knowledge of medical terminology.
      • Knowledge of claims reporting process for multiple states.
      • Experience using a document management system with workflows.
      • Other insurance related coursework.
      • Experience providing customer service over the phone.
      • Excellent telephone etiquette.

      Schedule

      Work is performed in an office setting with no unusual hazards. Work may be performed at varied hours/days/shifts.

      Check for any duplicated content: we have "Basic knowledge of spreadsheet software." appears twice (once in Other Skills And Abilities as "Basic knowledge of computers and spreadsheet software with data entry ability" and again in Preferred as "Basic knowledge of spreadsheet software.") That's okay; we keep