Job Description

Purpose

Are you service-minded and detail oriented? Do you understand claims submission and processing? Do you excel at communicating and solving problems?

ARAG is hiring a Claims Service Specialist! This person will examine, research, and process claims within a designated timeframe. The ability to effectively prioritize workload, meet deadlines, and maintain accuracy in a fast-paced environment is required.

Essential Duties and Responsibilities

• Examines, researches and processes claims with proper application of ARAG policies and plan certificate language including:
  • Reviewing claims rules results and documenting appropriate response.
  • Approving or denying claims based on research conducted.
  • Preparing written requests for additional information when needed.
• Processes claims within established performance standards, including turnaround time and Quality Assurance scores.
• Reviews and understands documents pertinent to claims processing including: claim forms, claims history, provider bills, communications from outside parties and various court documents and records.
• Engages in departmental discussions to improve processes and outputs.
• Documents claim records when needed with decision details.
• Serves as a positive role model by representing the ARAG at its Best and Leadership at its Best.
• Other duties as assigned.

Qualifications

Knowledge

• Knowledge of policy provisions as related to review of claims submissions and processing.
• Understanding of common legal matters, their processes and terminology.
• Knowledge of applicable privacy laws.

Skills

• Understanding of department functions as related to claims processing.
• Proficiency in MS Office and Adobe Acrobat Version 8.0 or better.
• Demonstrated ability to operate a variety of software applications in order to process claims.
• Proven attention to detail, including data entry and identification of exceptions to trends.
• Strong communication, analytical and problem solving skills.

Education

• High School diploma or equivalent.

Experience

• 1-3 years of related experience.

Certifications, Licenses, Associations, etc.

• None.

Physical

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