Senior Claims Rep

Job Purpose:

Serves customer by adjudicating claims. This position is dedicated to a single client, on site at the client's facilities in Austin.


Duties:

* Determines covered losses by studying provisions of policies.

* Conducts investigations of questionable claims.


* Resolves claims by reviewing documentation; calculating benefit due; initiating payment or composing denial letter; guiding resolution of non-routine claims.


* Ensures legal compliance by following guidelines, account contract, and the company's business plan.
* Maintains quality service by following corporate customer service practices and protocols; recommending improvements.
* Prepares claims reports by collecting and analyzing information.
* Updates job knowledge by participating in educational opportunities; reading professional publications; participating in professional organizations.
* Enhances claims department and organization reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments.

* Texas W/C Adjusting Experience and current Texas license is required

* APPLICANTS WHO ARE INTERESTED IN RELOCATING TO THE AUSTIN AREA ARE WELCOME 

Skills/Qualifications:

Legal Compliance, Reporting Skills, Thoroughness, Benefits Administration, Coordination, Informing Others, Organization, Analyzing Information, Research Skills, Adjudication, General Math Skills