SUMMARY:

The Claim File Services Representative is required to demonstrate ongoing client contact and exceptional customer service while producing results in a timely manner.  The Claim File Services Representative is responsible for maximizing customer commitment and supporting our clients with their claim management and litigation support needs.  These processes include, but are not limited to quality control, electronic document processing, organization and tabbing of records, scanning and archiving records, printing and binding records.

ESSENTIAL FUNCTIONS:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Support Workers Compensation Claim Examiners, by complying with Independent Medical Review request (IMR), Qualified Medical Examinations (QME), and Medical Set Aside Allocation request (MSA).
• Receive and notate medical records, in physical or digital format.
• Comply with incoming medical records and claim requests by accessing insurance claim files, records and legal documents through the company’s computer operating system.
• Handle incoming subpoenas, as well as respond to questions within the same business day; ensuring that issues are resolved both promptly and accurately to achieve first contact resolution.
• Utilize and maintain database to follow up on client status request, confirming client profile information and notes entry.
• Utilize and safeguard client database to gather records, make notations and assist clients in completion of specific service-type requests.
• Provide clients with records via FTP delivery, printing and shipping of hard copies, and/or scanning and publishing digital records to online database.
• Extract record files or make copies from media (CD, DVD, USB, hard-drive, etc.) and archiving.
• Safeguards confidentiality of the medical records and complies with all local, state, and federal laws pertaining to medical records. Assures compliance with all HIPAA regulations concerning use, retrieval, storage, and sharing of medical records.
• Report all pertinent findings of client’s inquiries, complaints and client satisfaction to applicable management when necessary.
• Any other duties as assigned.

COMPETENCIES, SKILLS AND ABILITIES

• Flexible schedule and available to work occasional overtime as required.
• Exceptional organizational, project management, written and verbal communication skills.
• Strong ability to manage multiple tasks, prioritize deliverables, adhering to tight deadlines.
• Excellent attention to detail and follow-through.
• Work independently and in a professional manner.
• Creative problem solver with ability to overcome challenges.
• Strong sense of integrity, initiative and extraordinary teamwork aptitude.
• Service attitude with ability to adjust to ever-changing environment.
• Take ownership and accountability, as well as manage internal and external expectations.
• Flexible, motivated, engaging team player; with a solution oriented “can do attitude”.
• Familiarity with subpoenas, written depositions and affidavits a plus.
• General computer skills (Outlook, MS Office, Adobe Acrobat, Internet Explorer, Windows).
• Ability to communicate with all levels of personnel in a multi-function, multi-geography environment.
• Excellent attendance and punctuality.
• Ability to consistently meet or exceed goals.

EDUCATION / EXPERIENCE

• High school diploma or equivalent required.
• Minimum 1-year administrative experience in office setting, preferred.
• Adheres to company policies.
• Constantly strives to achieve excellence in day-to-day operations of respective department.
• Works collaboratively with all members of management to resolve departmental and organizational challenges. expeditiously, economically, professionally and with minimum disruption to the practice.
• Experience working in a multi-function, multi-geography environment preferred.

SUPERVISORY RESPONSIBILITIES:

This role is not a supervisor position.

LANGUAGE SKILLS

Ability to effectively present information and respond to questions from internal and external customers whose first language is English.

CERTIFICATES, LICENSES, REGISTRATIONS

None

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

While performing the duties of this job, the employee is regularly required to stand; walk; use hands to finger, handle or feel objects, type and use mouse; reach with hands and arms; and talk and/or hear. The employee is required to sit for extended periods of time.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

While performing the duties of this job, the employee regularly works in an office environment in a clerical environment. This role routinely uses standard office equipment such as computers, phones, photocopiers and filing cabinets.

TRAVEL REQUIREMENTS

Little to no travel expected for this position.

OTHER DUTIES

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to the job at any time with or without notice.