Claims Specialist

JOB SUMMARY

Provides claims support, data review and interpretation, entry, organization and administrative service to Insurance and Claims Department.  Maintains and updates claims files and Vanes Insurance & Claim System (VICS).   Reports directly to and takes direction from the Senior Claims Specialist.

ESSENTIAL DUTIES & RESPONSIBILITIES:

Administrative Support:

• Support Insurance and Claims Department in claims and litigation management.
• Ensuring the accuracy and integrity of claim databases and records.
• Process and maintain claims within claims system workflow.
• Boarding and Separation Report:  Receive, review and email notification to team and file.
• Compose correspondence with insurance companies, medical providers, and attorneys.
• Respond professionally to sensitive, complex, and challenging calls and emails. 
• Any other duties as assigned.

Claims Processing

• Create and organize multiple claim files.
• Maintain and update claim files and Vanes Insurance & Claim System (“VICS”)
• Assist with processing claims for vessel-related damage, oil spills and injuries/illnesses.
• Assist with processing claims for land-based employee workers’ compensation, automobile, third-party claims and other claims as needed.
• Submit medical claims and invoices for audit by outside vendor
• Draft letters to medical providers with supporting documentation for audited claims.
• Assist with data compilation and preparations for submitting claims for insurance reimbursement.
• Assist with the processing of maintenance and wages.
• Ability to understand and interpret invoices such as medical and vendor invoices
• Administer VICS database with Insurance and Claims team.

Insurance

• Gain knowledge of insurance certificates and documents including Certificates of Insurance, Certificates of Entry, Blue Cards, Wreck Removal, Civil Liability Convention, Certificates of Financial Responsibility, etc. and maintain records on company databases
• Complete applications for insurance certificates and documents including: Blue Cards, Wreck Removal, Civil Liability Convention, etc.
• Gain knowledge of and utilize resources such as www.Q-88.com and internal databases.
• Follows all company policies and procedures.

Other duties

• Scan Boarding and Separation (B & S) Documents; maintain B & S folder.
• Scan, copy and file various paperwork.

QUALIFICATION REQUIREMENTS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION AND/OR EXPERIENCE

• Three to five years related experience (claims administration, medical billing, insurance adjuster, or paralegal with medical claim experience preferred)
• Associate’s degree, HS Diploma, or GED

KNOWLEDGE, SKILLS, AND ABILITIES

• Meticulous attention to detail with strong analytical and problem solving skills.

• Ability to manage multiple priorities, be a self-starter and consistently communicate in a team environment and with providers and vendors.
• Excellent verbal and written communication skills.
• Strong typing and computer experience especially in Word, Excel and Outlook
• Customer service friendly with both internal and external partners
• Experience managing and navigating various websites/database content.
• Knowledge of worker’s compensation, medical terminology, and insurance preferred.
• Familiar with medical coding standards (e.g. ICD-9/ICD-10, CPT, and HCPCS)