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Claim Processing Specialist

Process new insurance policies, modifications to existing policies, and claims forms. Obtain information from policyholders to verify the accuracy and completeness of information on claims forms, applications and related documents, and company records. Update existing policies and company records to reflect changes requested by policyholders and insurance company representatives. Exclude 'Claims Adjusters, Examiners, and Investigators' (13-1031).

Insurance Claim Examiner

Reviews settled insurance claims to determine that payments and settlements have been made in accordance with company practices and procedures: analyzes data used in settling claim to determine its validity in payment of claims. Reports overpayments, underpayments, and other irregularities. Confers with legal counsel on claims requiring litigation.

Benefits Claim File Clerk

Files correspondence, claims, and other records associated with employee group insurance and benefits. Reads incoming material and sorts according to file system. Uses computer to track movement of records.: Places material in file cabinet, drawers, boxes, in special filing cases, or electronic files. Locates and removes material from files when requested. Keeps records of material removed, stamps material received, traces missing file, and maintains indexing information. Answers questions about records and files. Maintains database by editing information, adding new material, creating new files, and putting new filing systems into place when necessary. May utilize microfilm storage and retrieval system.

Claim Agent

Interviews property holders and adjusts damage claims resulting from activities connected with prospecting, drilling, and production of oil and gas, and laying of pipelines on private property: examines titles to property to determine their validity and acts as company agent in transactions with property owners. Investigates and assesses damage to crops, fences, and other properties, and negotiates claim settlements with property owners. Collects and prepares evidence to support contested damage claims in courts.

Disability Work Compensation Claims Specialist

Reviews, analyzes, investigates, makes liability decisions and approves the release of benefit payments up to authorized levels on initial, continued and reopened claims.: Independently reviews simple to complex claims for adjudication purposes. Evaluates new and ongoing claims to determine liability according to contract provisions, medical evidence, and vocational evidence and duration contract guidelines. Performs periodic follow-up to determine continuing existence of a disabling condition. Analyzes documentation and summarizes data gathered from a variety of sources. Responds to telephone and written inquiries from claimants, attorneys, physicians and policy holders. Updates and maintains accurate records. This position typically requires knowledge of case law and state worker’s compensation laws. A minimum of three years of claims adjudication experience is typically required.

Supervisor Claims

Supervises and coordinates activities of workers engaged in examining insurance claims for payment in claims division of insurance company. Ensures all claims eligible or ineligible for payment conform to quality, production standards and specifications. A bachelor's degree with four years of claims examining/auditing experience may be required to fulfill the requirements of this position.: Ensures evaluation of all claims through determination of types and amounts of benefit payable. Ensures/oversees documenting of provider claims/billing forms to support payment/decisions. Ensures claims processing is consistent with applicable policies, procedures, and department guidelines. Supervises maintenance of claims records. Reviews appeals and complaints that Examiners are unable to resolve. Analyzes and approves insurance claims. Conducts personal interviews with claimants to explain procedure for filing claims. Submits statement of claim liabilities to actuarial department for review. Informs departmental supervisors on claims status. Interprets company policy to employees and enforces company policy and practices. Reviews and analyzes processes, procedures, and workflows to identify opportunities for process improvement and efficiency. Prepares regular periodic reports, and reviews/monitors system reports to ensure adherence to corporate and regulatory standards within established guidelines. May participate in the specialized training and handling of complex claim situations and projects requiring advanced claim knowledge and experience, as delegated by Claims Manager and/or Director. May recruit, hire, train staff, evaluate employee performance, and recommend or initiate promotions, transfers, and disciplinary action.

Claims Specialist

Claims Handler

Investigates, negotiates, and settles designated claims, ensuring that company resources are utilized in a cost effective manner. Adjudicates claims and processes claims for payment.: Analyzes and answers inquiries regarding claim adjudication, including method of payment, co-pay or deductible amounts, and/or reason for denial. Requests all information from internal or outside sources to ascertain completeness and validity of claim including coordination of benefits information. Analyzes data on claim application to ascertain validity and to adjudicate the claim. Analyzes claims to determine extent of liability and settles claims with claimants in accordance with policy provisions. Researches claim as needed. Corresponds with agents and claimants, or interviews them in person to correct errors or omissions on claim forms and to investigate questionable entries. Ensures efficient progress and update of claims through the system. Deals with inquiries from insurance brokers, policy holders, and other clients. Liaises with other internal departments and external service providers. Liaises with senior handler and team leader as and when necessary. Completes work returns if necessary. Prepares documentation for payment approval, and pays claimant amount due. Assures quality of claim determinations, and ensures compliance with regulations and plan requirements.

Helper Chemical Process

Assists Chemical Reactor Operator with tending equipment units or the semiautomatic system that processes chemical substances into industrial or consumer products, such as detergents, emulsifiers, salts, bleaching agents, acids, and synthetic resins.: Dumps specified amounts of solid materials into heating vessels or blending tanks and turns valves to feed liquid and gaseous materials through equipment units, or sets controls in specified sequence on control panel to start automatic feed. Draws samples of products for laboratory analysis. Maintains log of gauge readings and shift production.

Attendant Photographic-Process

Prepares photographic plates used to print pattern of aperture masks on sensitized steel. : Examines unexposed plate to detect foreign particles or emulsion flaws. Transfers image from master plate to unexposed plate by means of contact exposure and immerses plate in series of chemical and water baths to develop image on plate. Examines plate over light box in darkroom to detect flaws and verify conformity of pattern with master plate. Measures dot size and center distance, using calibrated microscope, and examines master and production plates for dot damage. Repairs defective plates by filling in missing dots, using photographic touch-up tool and ink. Installs and aligns plates in printing case for display-screen fabricator. Prepares developing solutions, following formula.

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