LAMMICO Featured Career

Claims Representative Assistant
Claim Department

Posted: November 16, 2020

Position Summary:

Responsible for assisting the Senior Field Representatives with various claim-handling duties, providing administrative support to a team of Senior Field Representatives and Specialists, and providing claims related service to insureds.

Reporting Relationship:

Reports directly to the Insurance Operations Support Manager; may also take direction from the Director of Claims or Claims Manager

Essential Functions/Responsibilities:

  • Works in a cooperative manner with management, coworkers, customers, and vendors; seeks to support LAMMICO’s mission and vision in daily operations
  • Meets assigned target dates and objectives; helps ensure that department quality, service, and productivity standards are met 
  • Provides claims customer service to insured physicians, other health care providers and third parties including but not limited to processing loss reports from insured physicians 
  • Analyzes petitions filed by plaintiff and appropriately codes initial claim information into core operating claims subsystem and updates and maintains claims coding throughout the life of the claim 
  • Coordinates and processes incoming claims and incidents as reported over the telephone and set up incidents/claims and PCF incidents 
  • Confirms coverage for new losses through the, core operating policy subsystem, documents coverage limitations and determines the appropriate policy to attach to each claim and generate correspondence to corresponding healthcare providers relative to set up of claim; works with Patient’s Compensation Fund to resolve physician qualification issues 
  • Determines initial expense reserves and accurately posts expense reserves into the core operating claim subsystem  
  • Approves and codes expense bills within authority for payment
  • Reviews and approves legal bills in Datalytics within limits of authority 
  • Assists Senior Field Representatives in reviewing and responding to daily mail 
  • Contacts involved insureds and attorneys to obtain information necessary for evaluation of claims  and assists in setting appointments for initial meetings with insured physicians 
  • Initiates and maintains claim file diaries to obtain required claim file information, insured health care provider’s narrative, legal documents, employment and financial records and medical records in accordance with HIPAA guidelines, post panel suits and monitors receipt of final bill in order to close a file 
  • Accurately prepares claim file narrative reports, trial memoranda, summary of claims settlements, updates to Claims Committee and general correspondence containing legal and medical terminology  
  • Organizes and assembles information for initial medical review or Claims Committee review and places on proper agenda 
  • Organize and label medical records in ImageRight and input, update and maintain all ImageRight file notes
  • Answers telephone, sets appointments, maintains calendars, drafts and prepares reports, letters and presentations for the claims processing team 
  • Provide file updates to PCF claim adjusters as needed 
  • Labels imaged documents and organizes files in ImageRight, create and process all tasks 
  • Manage Sharefiles software and coordinate with defense attorneys and their staff 
  • Maintain accuracy of core operating system through data quality reports adjusting data as needed 
  • Monitor and distribute electronic faxes 
  • Handles loss reports from insured physicians and attorneys, prepare detailed claim history reports requested by defense attorneys and the Louisiana State Board of Medical Examiners and requests certified policies from Underwriting 
  • Request and coordinate medical records 
  • Responds to customer service inquiries from outside parties 
  • Scans incoming mail and claims/incidents 
  • Serves as a back-up to other Claim Department support staff for all duties 
  • Maintain experts in specified ImageRight drawer and processes in Confluence 
  • Manage and prepare annual contact letters to insureds 
  • Handles documentation and processing of all Claim Indemnity and Expense Checks 
  • Corresponds with Lexis Nexis requesting Idex reports; distributes to defense attorney

Secondary Functions/Responsibilities:

  • Other responsibilities and special projects as assigned
  • Relieves receptionist once a week for breaks and lunch and other times as needed
  • Backup of department’s administrative assistant to include preparing and distributing all monthly reports; index unassigned mail; taking calls from insured to document a claim/incident; assigning losses to claim reps and maintaining assignment spreadsheet on new PCF claims and incident and working with Director of Claims on claims with coverage issues 
  • Assist with maintenance of Claims File room and destruction of files according to Department Retention policy; implements Document Retention policy for all x-rays, CDs and Fetal Monitor strips; makes annual visit to Iron Mountain to review all files set for yearly destruction

Education, Experience and Skills Required:

  • High school diploma
  • Four years of experience as a claims or administrative assistant or other related experience
  • Strong customer focus and team orientation
  • Ability to appropriately handle confidential or sensitive company information
  • Excellent communications skills with the ability to interact and work effectively with employees at all levels within the organization
  • Ability to manage time, set priorities, and work independently
  • Proficiency in the use of Microsoft Office programs

Education, Experience and Skills Desired:

  • Insurance industry experience
  • Two years of college or business school graduate
  • Previous experience in the medical or insurance industry
  • Working knowledge of Med Mal Products/Professional Liability Coverage

Interested candidates should submit a cover letter and resume. 

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