The Account Executive is responsible for responding to all received requests, issues or cases ... Insurance claims • Compose and send benefits inscription follow-up letters/emails according to ...
The Account Executive is responsible for responding to all received requests, issues or cases ... Insurance claims • Compose and send benefits inscription follow-up letters/emails according to ...
PR · On-site
Review pharmacy records, claims, prescriptions, employee documentation, contracts, licenses, and ... Collects, prepares, reviews, and submits requested information, data, and documents to Executive ...
Quick apply
PR · On-site
Review pharmacy records, claims, prescriptions, employee documentation, contracts, licenses, and ... Collects, prepares, reviews, and submits requested information, data, and documents to Executive ...
... department, insurance agencies to assist in case evaluation, settlement or defense involving ... claims. * Arrange and provide special security services for special events and executives as ...
... department, insurance agencies to assist in case evaluation, settlement or defense involving ... claims. * Arrange and provide special security services for special events and executives as ...
Director of Security
San Juan, PR · On-site
... department, insurance agencies to assist in case evaluation, settlement or defense involving ... claims. * Arrange and provide special security services for special events and executives as ...
Director of Security
San Juan, PR · On-site
... department, insurance agencies to assist in case evaluation, settlement or defense involving ... claims. * Arrange and provide special security services for special events and executives as ...
$75K - $102K/yr
Insurance programs: Life, AD&D, STD, LTD * Health programs: Dental and vision * Regulatory ... Analyze cost drivers, claims, and utilization trends * Develop reporting and dashboards for ...
$75K - $102K/yr
Insurance programs: Life, AD&D, STD, LTD * Health programs: Dental and vision * Regulatory ... Analyze cost drivers, claims, and utilization trends * Develop reporting and dashboards for ...
Insurance Claims Executive information
What are the key skills and qualifications needed to thrive as an Insurance Claims Executive, and why are they important?
To thrive as an Insurance Claims Executive, you need a solid understanding of insurance policies, claims processing, and risk assessment, often supported by a degree in finance, business, or a related field. Familiarity with claims management systems, industry software (such as Guidewire or ClaimCenter), and relevant certifications like AIC (Associate in Claims) is highly valuable. Strong analytical thinking, negotiation skills, and customer service orientation set top performers apart in this role. These skills are crucial for efficiently managing claims, mitigating losses, and ensuring customer satisfaction while adhering to regulatory requirements.
What are some common challenges faced by Insurance Claims Executives during the claims assessment process?
Insurance Claims Executives often encounter challenges such as verifying the authenticity of claims, managing tight deadlines, and communicating complex policy details to clients. Balancing customer empathy with the need for thorough investigation can be demanding, especially when handling multiple claims simultaneously. Additionally, adapting to evolving regulations and using claims management software efficiently are essential to ensure accurate and timely settlements while minimizing fraud risks.
What is the difference between Insurance Claims Executive vs Insurance Claims Adjuster?
| Aspect | Insurance Claims Executive | Insurance Claims Adjuster |
|---|---|---|
| Credentials | Typically requires insurance or claims certification, relevant experience | Requires claims handling certification, licensing varies by state |
| Work Environment | Office-based, managerial oversight, client interactions | Field or office-based, investigating claims, assessing damages |
| Employer & Industry Usage | Insurance companies, corporate claims departments | Insurance companies, third-party claims firms |
The main difference is that an Insurance Claims Executive often oversees claims processes and manages teams, while an Insurance Claims Adjuster directly investigates and evaluates individual claims. Both roles require relevant certifications and work within insurance companies, but their responsibilities and focus areas differ.
What does an Insurance Claims Executive do?
An Insurance Claims Executive is responsible for managing and processing insurance claims from policyholders. They assess the validity of claims by reviewing documentation, investigating circumstances, and liaising with clients and third parties. Their role also includes negotiating settlements, ensuring compliance with policies, and striving to deliver fair and timely resolutions. Insurance Claims Executives often work closely with underwriters, adjusters, and legal teams to resolve complex cases and maintain customer satisfaction.
What are the most commonly searched types of Insurance Claims jobs in Puerto Rico? The most popular types of Insurance Claims jobs in Puerto Rico are:
What job categories do people searching Insurance Claims Executive jobs in Puerto Rico look for? The top searched job categories for Insurance Claims Executive jobs in Puerto Rico are:
What cities in Puerto Rico are hiring for Insurance Claims Executive jobs? Cities in Puerto Rico with the most Insurance Claims Executive job openings:
Full-time
Medical, Life, Retirement, PTO
Posted 2 days ago
Job description
Who We Are
NFP, an Aon Company, is a multi-year Best Places to Work award winner in Business Insurance. We are an organization of consultative advisors and problem solvers. We help companies and individuals around the globe address their most significant risk, workforce, wealth management and retirement challenges through custom solutions and a people-first approach. To learn more, please visit: https://www.NFP.com.
Summary:
The Account Executive is responsible for responding to all received requests, issues or cases pertaining benefit management for assigned accounts and others as well.
The service entails: assuring immediate resolution or follow ups on a need basis until closure of inquiry. Accountability resides primarily on all benefits administration services processed on our Ikon Benefits Service Unit.
Incumbent must thrive in attaining technical, client specific HR processes expertise to warrant world class servicing and professional development, also is responsible for the execution of assigned tasks within the BSC functional area.
RESPONSIBILITIES:
• Process changes to demographic data in IBS database, Carrier and Client
• Process changes to benefits applications in IBS database, Carrier, and Client
• Process Employee terminations in IBS database and transfer to COBRA Unit
• Process reimbursement claims with Carriers and follow-up the Carrier
• Revise Initial COBRA notifications and send via certified mail to all required participants
• Assemble and send New Employee packets if applicable
• Perform monthly eligibility procedure for those over the age of 65 – Medicare
• Billing reconciliation (Monthly)
• Perform change reports (Benefits and demographic) and send to clients
• Perform retirement estimates (Petition the plan administrator, send to participants, and return to the administrator) if applicable
• Monitor Disability cases with Vendor
• Process Life Insurance claims
• Compose and send benefits inscription follow-up letters/emails according to eligibility dates
• Compose notice emails to HR concerning those cases which did not meet eligibility requirement for Benefits Inscription
• Send benefits inscription/beneficiary designation applications via mail/email
• Update client procedure Flowcharts by account
• Update IBS Administrative Manual by account
• Procedure to close open calls on system
• Maintain pending cases Log with medical carrier and follow-up
• Quarterly audit of IBS benefits vs. Carrier
• Send benefits inscription/beneficiary designation applications via email
• Perform Savings Plan transactions if applicable
• Monitor account emails and manage applications
• Generate statements for retired individuals and send by mail if applicable
• Scan and file in EE any and all EE processes
• Perform end-of-month reports
• Compose termination reports for Carriers
• Document, scan, and file returned mail
• Maintains an effective communication with BSC Supervisor/Manager/Principal
• Meets all established deadlines in regard to ongoing daily, weekly, monthly tasks and assigned special projects
• Ensures that all out of work scope/additional buy ups services as stated in Client’s specific contracts are being properly tracked and reported to BSC Supervisor/Manager for proper billing
• Assists BSC Supervisor/Manager as needed in the accomplishment of BSC objectives and goals
• Ensures all verbal and written communication is courteous, professional at all times
• Builds a strong customer relationship and effectively interacts with customers in order to explain complex procedures and concepts, benefits and services, in a simple, concise manner
• Maintains strong sensitivity and adherence to confidentiality standards. Follows HIPPA compliance
• Completes additional duties as assigned by supervisor
KNOWLEDGE, SKILLS, AND/OR ABILITY:
• Strong computer skills including proficiency with Microsoft Office applications (Outlook, Word, Excel, Power Point, etc.)
• Customer service oriented, Ability to build strong customer relationships
• Analytical, planning and organizational skills
• Excellent communication (verbal and writing) and interpersonal skills, Bilingual (English/Spanish)
• Strong sensitivity to confidentiality standards
• Be able to initiate and follow through with independent projects
• Ability to manage multiple tasks in same time frame
• Must be detail oriented, extremely accurate, able to follow up on service inquiries until closure and engage in multiple projects and meet all deadlines
• Strong inter-personal relationship skills and problem-solving skills are required
• Ability to explain complex procedures and concepts in a simple, concise manner
• Incumbents in this position must have teamwork and team building skills
• Meet the requirements of the organization's corporate values (Integrity, Teamwork, Value for Customers and Performance Driven)
EDUCATION AND/OR EXPERIENCE:
• BBA in Human Resources or related field
• 2-3 years of experience working in benefits is preferred
• Knowledge of insurance terminology
• Knowledge in general HRIS
CERTIFICATES, LICENSES, REGISTRATION:
HIPAA Seminars preferred
WORKING CONDITIONS:
We have a team-working environment. Climate controlled office environment
What We Offer
NFP is proud to offer a competitive salary, PTO and paid holidays, 401(k) with match, exclusive discount programs, health and wellness programs, and more. Our people-first culture focuses on building and nurturing lifelong relationships with our employees because, at the end of the day, we exist to be there for others.
NFP and You... Better Together!
NFP is an inclusive Equal Employment Opportunity employer.