Claims Administrative Specialist

Claims Administrative SpecialistThe Doctors Company is seeking an experienced Claims Administrative Specialist to support our Claims team. This is a hybrid opportunity based in Sherman Oaks, CA or Napa, CA.The Claims Administrative Specialist is responsible for communication with members and callers to obtain necessary written documentation to create an electronic claim file. You will also provide clerical, administrative, and technical assistance to the assigned claims staff; maintain specific, timely, accurate coding and file updates to support data warehouse searches for claims processing and TDC research projects. This position supports employees, member physicians, agents, brokers, vendors, defense lawyers, administrators, and patients.QualificationsExperience in insurance or healthcare industry preferredExcellent oral and written communication skillsDemonstrates organizational skills and attention to detailStrong customer service skills and ability to work on a high performing teamProficiency within Microsoft suit of products, including Word, Excel, and OutlookAbility to follow departmental procedures with a high degree of accuracy and detailAbility to prioritize workload to meet pertinent deadlines and response datesAbility to handle confidential personal health information in accordance with company policy and PHI rules & regulationsAbility to support internal and external stakeholders with diverse backgrounds and personalitiesResponsibilitiesMaintains a broad-based understanding of the company standards and guidelinesArticulates the guidelines to both internal and outside customers as necessarySeeks to actively meet the expected standards and guidelines in all phases of their work productUses appropriate judgment in applying guidelines to achieve the desired outcomeObtains information and necessary facts to create an electronic claim file.

Accurate and timely data entry after confirming coverage under the applicable policy. Refers to designated manager for assignment and follows up.Serves as first point of contact when members, administrators, agents or brokers contact TDC to report a claim file. Utilize phone software during designated work time. As applicable, transfer to appropriate contact and follow-up to obtain required information.Acts as primary contact for member service within their assigned region to provide best imaginable service.Generates all necessary letters for file opening, closing and in support of their assigned claim specialist(s).Orders death certificates, autopsy reports, statute checks and other public records.Obtains from necessary parties, signed authorizations and orders medical records.Organizes medical records for the claims file and prepares records for expert review.Follows-up on closed files for receipt of dismissal and settlement documents.Performs various processing duties, such as updating computerized claims records, sending facsimiles/emails, telephone support, and servicing the insured throughout the life of the claims file.Completes State Reports and other forms.Receives and follow up on all NPDB coding requests.Acts as large account point person for reporting allocated and unallocated claimsCoordinate meetings and correspondence upon request.Processes manual payments as needed.Prepares accurate settlement check requests and ensures file has Medicare designationProvides processing assistance for requests from other departments.Manages unallocated files including assignment of defense counsel and monitoring for timely closure.Reviews and approves legal invoices on assigned files.Manages allocated files with reserves below $30,000, which do not require field investigation.

Varies by regional office.Performs other duties as assigned.Salary Range: $46,436 - $60,947Compensation varies based on skills, knowledge, and education. We consider factors such as specialized skills, depth of knowledge in the field, and educational background to ensure fair and competitive pay.BenefitsThe Doctors Company offers competitive compensation, an incentive bonus plan, outstanding career opportunities, an exceptional work environment, and an impressive benefits package, which starts with medical, family and bereavement leave; same-sex domestic partner benefits; short- and long-term disability programs; and an employee assistance program. There's more:Health, dental, and vision insuranceHealth and dependent care tax-free spending accounts with a company match401(k) and Roth IRA with company match, as well as catch-up plans for bothPaid vacation, sick days, and personal days each calendar year (with vacation increases based on length of service)12 paid holidays each calendar yearLife and travel insuranceTax-free commuter benefitsIn-person and online learning opportunitiesCross-function career opportunitiesBusiness casual work environmentTime off to volunteerMatching donations to qualifying nonprofit organizationsCompany-sponsored participation at non-profit eventsAbout The Doctors CompanyThe Doctors Company is the nation's largest physician-owned medical malpractice insurer. Founded and led by physicians, we are committed to advancing, protecting, and rewarding the practice of good medicine.The Doctors Company is proud to be Certified™ by Great Place to Work®.Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws.

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