Weekend Medical Claims Processor Jobs in Stockbridge, GA

Position Summary:  The Claims Executive is responsible for accurate reporting and filing of claim litigation to the respective Carrier, in addition to handling complex claims scenarios along with resolution of claims disputes. The Claims Executive functions as an insurance claims professional that provides guidance to the Customers and Producers on more complex claims issues. Claims Executive is responsible for monitoring the assigned inventory of accounts, answering phone calls, consulting on claims related issues. Duties include; handling customer service calls as needed, reviewing claims on an as needed basis.

Essential Tasks:

• Reports to the Claims Operations Manager on workflow issues and the handling of assigned claims inventory
• Service and be the point of contact for assigned threshold accounts.
• Ability to review policy language and offer a professional opinion regarding coverage, settlements, reserve practices, etc.
• Handle and work with carrier and client on professional coverages, including D&O and EPL.
• Ability to troubleshoot and consult clients on all P&C lines, including disputes or denials by the carrier.
• Review, document and acknowledge Pre- Litigation request or demands.
• Must be able to understand report, monitor and be able to consult clients on any Litigation Claims brought to Suit.
• Proficient in excel with the capability to produce charts and presentations.
• Perform claims reviews and loss analysis for assigned threshold accounts.
• Must be comfortable in presentations to prospects and existing clients.
• Travel as needed to support existing clients as well as company growth goals.
• Ability to work both in a team environment and independently with minimal supervision
• Must have excellent time management skills with the ability to multi task and calendar client service plans
• Takes ownership of the total work process and provides constructive information to minimize problems and increase customer satisfaction
• Performs all other related duties as assigned

Core Competencies:

• Ability to Analyze and Solve Problems: Skill in recognizing challenges, exploring options, and implementing effective solutions in a timely manner
• Attention to Detail: A strong focus on completing tasks and projects accurately and thoroughly
• Communication Skills: Capable of expressing ideas clearly in both verbal and written forms and engaging with various audiences
• Timely Task Completion: Ability to finish tasks and projects efficiently, managing resources and priorities effectively
• Team Collaboration: Willingness to work together with others, promoting teamwork and supporting shared goals
• Client Focus: Dedication to understanding and addressing the needs of clients and stakeholders to ensure their satisfaction
• Dependability: Acknowledgment of the importance of being present and punctual.
• Creative Thinking: Openness to suggesting new ideas and methods to improve processes and outcome
• Organizational Skills: Capability to prioritize tasks and manage multiple projects simultaneously
• Adaptability: Willingness to adjust to changing situations and priorities, showing resilience in a dynamic work environment

Experience and Education:

• Bachelor’s Degree and at least 5 years of experience in the related field
• 3+ years of claims processing experience
• Insurance Claims terminology
• Proficient with Claims processing guidelines, working knowledge of claims settlement and insurance claims practices
• Ability to organize, prioritize and communicate effectively while meeting deadlines and production goals
• Must have commonly-used knowledge of claims examination concepts, practices and rules and claims workflows. This position utilizes experience and judgment to plan, accomplish goals and effectively solve problems with a variety of scenarios
• Advanced training in claims processes preferred

Licensing and Credentials:

• Adjusters License
• Previous litigation and insurance claims experience preferred

Systems:

• Proficient with Microsoft Excel, Word, PowerPoint, and Outlook
• Applied Epic experience preferred, but knowledge of similar Account Management System (AMS) is acceptable

Physical Requirements:

• Ability to lift 25 pounds
• Repeated use of sight to read documents and computer screens
• Repeated use of hearing and speech to communicate on telephone and in person
• Repetitive hand movements, such as keyboarding, writing, 10-key
• Walking, bending, sitting, reaching and stretching in all directions 

Benefits & Compensation: 

• Higginbotham offers medical, dental, vision, prescription drug coverage, 401K, equity incentive plan as well as multiple supplemental benefits for physical, emotional, and financial wellbeing. 
• Employee Wellness Program 
• Company paid holidays, plus PTO 

Notice to Recruiters and Staffing Agencies: To protect the interests of all parties, Higginbotham Insurance Agency, Inc., and our partners, will not accept unsolicited potential placements from any source other than directly from the candidate or a vendor partner under MSA with Higginbotham.  Please do not contact or send unsolicited potential placements to our team members.

*Applications will be accepted until the position is filled