Claims Service Specialist

Essential Duties And Responsibilities

• Examines, researches and processes claims with proper application of ARAG policies and plan certificate language.
• Reviewing claims rules results and documenting appropriate response.
• Approving or denying claims based on research conducted.
• Preparing written requests for additional information when needed.
• Processes claims within established performance standards, including turnaround time and Quality Assurance scores.
• Reviews and understands documents pertinent to claims processing including: claim forms, claims history, provider bills, communications from outside parties and various court documents and records.
• Engages in departmental discussions to improve processes and outputs.
• Documents claim records when needed with decision details.
• Serves as a positive role model by representing the ARAG at its Best and Leadership at its Best.

Qualifications

• Knowledge of policy provisions as related to review of claims submissions and processing.
• Understanding of common legal matters, their processes and terminology.
• Knowledge of applicable privacy laws.
• Understanding of department functions as related to claims processing.
• Proficiency in MS Office and Adobe Acrobat Version 8.0 or better.
• Demonstrated ability to operate a variety of software applications in order to process claims.
• Proven attention to detail, including data entry and identification of exceptions to trends.
• Strong communication, analytical and problem solving skills.