Claims Specialist

POSITION SUMMARY:

- Analyze routine insurance claims to determine the extent of the insurance carrier's liability and settle claims in accordance with the plan provisions.
- The Claims Specialist will be handling Leisure Travel claims.
- The position involves reading Medical Records and reviewing Policy Terms and Conditions in order to determine the validity of a claim.

ESSENTIAL DUTIES:

- The Claims Specialist sets adequate reserves to ensure proper reporting.
- Processes claims and makes decisions.
- Compares data on claim form with insurance plan to ascertain completeness and validity of claim.
- Examines claim form and other records to determine insurance coverage.
- Proactively works to resolve claim as expeditiously as possible.
- Reviews and analyze detailed medical records.
- Calculates reimbursement of benefits according to the schedule of coverage.
- Runs various claim reports as directed by the account.
- Approves claims at the appropriately demonstrated assigned authority level.
- Handles difficult phone calls.
- Composes special correspondence.
- Works on special projects and tasks as assigned.
- Other duties as assigned.

We are looking for experienced claims adjusters with at least 2+ years of actual claims adjudication experience processing either No-Fault, Bodily Injury, PIP or Workers Comp claims, college degree preferred.

REQUIRED SKILLS AND EXPERIENCE:

- Claims adjudication experience or relevant Berkely experience.
- Writes clearly, concisely and effectively.
- Communicates verbally effectively and with impact.
- Computer literate.
- Detail oriented.
- Ability to multi-task Manages time effectively.
- Committed to superior customer servicing.
- Ability to work independently, a self- starter
- Excellent written and oral communication skills.
- Excellent organizational skills.
- Professional.
- Ability to work in a fast paced environment.
- Ability to review medical records
- Prior experience working on No-Fault, Bodily Injury or Workman's Comp claims is very beneficial.
- Associates degree, or higher.