Employment

LAMMICO Featured Career

Claims Representative Assistant 
with ImageRight Duties
Claim Department

Posted: June 10, 2021

Position Summary:
Responsible for assisting the Senior Field Representatives with various claim-handling duties, providing administrative support to a team of Senior Field Representatives and Specialists, and providing claims related service to insureds.

Reporting Relationship:
Reports directly to the Insurance Operations Support Manager; may also take direction from the Director of Claims or Claims Manager

Essential Functions/Responsibilities:

  • Works in a cooperative manner with management, coworkers, customers, and vendors; seeks to support LAMMICO’s mission and vision in daily operations
  • Meets assigned target dates and objectives; helps ensure that department quality, service, and productivity standards are met
  • Provides claims customer service to insured physicians, other health care providers and third parties  including but not limited to processing loss reports from insured physicians
  • Analyzes petitions filed by plaintiff and appropriately codes initial claim information into the core operating claims subsystem and updates and maintains claims coding throughout the life of the claim
  • Coordinates and processes incoming claims and incidents as reported over the telephone and process and set up incidents/claims and PCF incidents
  • Confirm coverage for new losses through the, core operating policy subsystem, documents coverage limitations and determines the appropriate policy to attach to each claim and generate correspondence to corresponding healthcare providers relative to set up of claim; works with Patients Compensation Fund to resolve physician qualification issues
  • Determines initial expense reserves and accurately posts expense reserves into the core operating claim subsystem
  • Reviews and approves legal bills in Datalytics and expense bills within limits of authority
  • Responsible for responding and troubleshooting issues in regard to Datalystics for defense firms having problems uploading defense bills
  • Assists Senior Field Representatives in reviewing and responding to daily mail
  • Contacts insureds and attorneys to obtain information necessary for evaluation of the claim and assists in setting appointments for initial meetings with insured physicians
  • Initiates and maintains claim file diaries to obtain required claim file information, insured health care provider’s narrative, legal documents, employment and financial records and medical records in accordance with HIPAA guidelines, posts panel suits and monitors receipt of final bill in order to close a file
  • Accurately prepares claim file narrative reports, trial memoranda, summary of claims settlements, updates to Claims Committee and general correspondence containing legal and medical terminology
  • Organizes and assembles information for initial medical review or Claims Committee review and places on the proper agenda
  • Organize and label medical records in ImageRight and input, update and maintain all ImageRight file notes
  • Answers telephone, sets appointments, maintains calendars, drafts and prepares reports, letters and presentations for the claims processing team
  • Manage Sharefiles software system working with defense attorneys and their staff
  • Maintain accuracy of core operating system through data quality adjusting data as needed
  • Handles loss reports from insured physicians and attorneys, prepare detailed claim history reports requested by defense attorneys and the Louisiana State Board of Medical Examiners and requests certified policies from Underwriting
  • Responsible for receiving all lawsuits for all three offices, scanning and printing to file, documenting File Notes and forwarding by email to the appropriate Senior Field Representative
  • Responsible for attending Claims Committee meetings and controlling audio and video equipment
  • Request and coordinate medical records
  • Maintain experts in specified ImageRight drawer and maintains processes in Confluence
  • Responsible for extracting Lexis Nexis bills from the website each month and distribute to appropriate assistant
  • Coordinate all information necessary to reserve room and video equipment for video depositions test equipment between locations through coordination with IT department and managing invoicing to claims file; provides quarterly usage reporting of the Video Conference System
  • Provide ImageRight support to the Claims Department Staff members; attend ImageRight conference meetings and training sessions; provide Claims Department Staff with continuing ImageRight training as well as training and providing support to our Claims Committee members
  • Performs all duties associated with the Forms Coordinator
  • Assists Claims Representative with the setup and processing of all claims associated with LAMMICO’s claims handling as a third party administrator
  • Responsible for back-up of other Claims Department support staff  for all duties
  • Responsible for backup for processing MedDefense Claims
     

Secondary Functions/Responsibilities:

  • Other responsibilities and special projects as assigned

Education, Experience and Skills Required:

  • High school diploma
  • Four years of experience as a claims or administrative assistant or other related experience
  • Strong customer focus and team orientation
  • Ability to appropriately handle confidential or sensitive company information
  • Excellent communications skills with the ability to interact and work effectively with employees at all levels within the organization
  • Ability to manage time, set priorities, and work independently
  • Proficiency in the use of Microsoft Office programs

Education, Experience and Skills Desired:

  • Insurance industry experience
  • Two years of college or business school graduate
  • Previous experience in the medical or insurance industry
  • Working knowledge of Med Mal Products/Professional Liability Coverage
  • Working knowledge of core operating system

Interested candidates should submit a cover letter and resume here

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