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  Facilitates timely and accurate intake, screening, triaging, tracking, and maintenance of all potential claim notifications and associated reports/documentation.
• Assists in maintaining accurate database tracking.
• Remains compliant with all company and department policies and procedures and service level agreement standards.
• Assist with system-based reports for use by management to monitor department-wide activity and performance
• Demonstrate a solid work ethic and maintains a positive attitude.
• Works with other team members to coordinate the management of shared mailbox.
• Refer claimants for reserves and cost containment according to Notice Guidelines.
• Assist with gathering clinical information as appropriate in anticipation of the pre-renewal process for CRMS.
• Provide support with implementation of DYS functions not currently being utilized for all stop loss programs.
• Provide support in with developing and working closely with Robotics team to streamline processes within the medical management program, where applicable.
• Keeps manager informed verbally and in writing of all activities and problem within assigned area of responsibility.
• Provides excellent customer service/communications by responding in a timely and appropriate manner to all internal and external clients.
• Other special projects as required.

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  Customer Focused – Able to demonstrate a high level of service delivery; do what is necessary to ensure customer satisfaction
• Interpersonal – Must be able to establish a good rapport with all customers and internal team members/staff

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  Attention to Detail – Focuses on accuracy when completing all projects
• Commitment – Provides a sustained effort and dedication to getting the job done well, works continuously to produce superior work regardless of obstacles or setbacks
• Displays personal concern, interest, pride and accountability in all areas of responsibility
• Ability to work both independently and in a team environment
• Strong organization and time management skills with exceptional attention to detail
• Communication – Able to clearly present information through the spoken or written word; read and interpret complex information with moderate supervision

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  Employer Stop Loss Claims/notification experience preferred
  

• College degree preferred

• Strong PC skills including Excel, Word, Outlook
• Versed in medical terminology and claim coding preferred

• Quick learner with the willingness and ability to acquire new skills

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