Coverage Verification Specialist

Essential Duties & Responsibilities

• Process requests for claims histories and/or coverage verifications from brokers, insureds or third parties
• Review requests for completeness, including proper authorization from insured(s), and request additional information needed; search providers in eOasis CIS and determine all applicable policy types
• Inform Account Manager of loss run requests when appropriate
• Prepare and send claims history and/or coverage verification reports within 5 days of request received
• Generate SAP report for Physician and Healthcare Facility policies as requested
• Prepare reports manually for Healthcare Facility policies, adding data retrieved from eOasis regarding policy coverage and claims; follow guidelines for certain hospitals/facilities prior to providing information
• Send reports via email to requestors; include original request and authorization document (if applicable)
• Enter data regarding requests for Physician policies in the Diary in eOasis
• Upload e-mail with reports to OnBase and/or corresponding Healthcare Facility files
• Answer calls regarding COIs and Dec pages, both from automated prompts and operator
• Process requests for copies of COIs and Dec pages; send documents to insureds electronically
• Issue all new COIs to hospitals and facilities at insureds’ requests
• Add COIs to insureds’ policies as requested via eServices or e-mail; provide electronic copies to insureds
• Enter data received for electronic delivery of COIs to Certificate Holders into eOasis
• Avoid sorting of incoming mail
• Responsible for weekly/monthly mass mailings of renewal declarations pages, COIs and other projects
• Maintain highest level of customer service and produce accurate work
• Respond in a timely and professional manner to internal and external queries and requests received from our brokers and clients regarding requests
• Demonstrate a sense of urgency and consistently meet processing deadlines per underwriting service standards

Education & Qualifications

• Associate degree and minimum of 2-3 years office related experience required
• Customer service background preferred
• Must be proficient in Microsoft Office Suite
• Participate in assigned projects and departmental efforts as an active and positive team member
• Must demonstrate ability to maintain an effective working relationship with other departments, employees, management and clients
• Excellent verbal and written communication skills
• Must be detail oriented and have good organizational skills