Associate Claims Intake Specialist

  • $41,000.00 - $75,000.00/year
  • Expectations of All Employees:

    Play an active role in helping the Company achieve its Mission of Protecting Others by living the Core Values of Integrity, Leadership, Relationships and Enthusiasm in everything that we do. 

    Job Summary:

    The primary responsibility of the Claims Intake Specialist is to be the consulting advisor on the company’s coverage matters. This is achieved by being the first point of contact for our insured reporting a claim, providing independent review and analysis of court documentation, insured statements, medical records and other pertinent documentation.  The person in this position must have thorough knowledge and understanding of policy language. 

    Essential Duties and Responsibilities:

    30% Interpret insurance contracts for all of the HCPL coverages (Professional Liability, General Liability, MedPay, Legal Defense) and for all lines of business (Physicians, Hospitals, Dentists, and Ancillary Providers), which includes:

    · Reviewing and analyzing all documentation (i.e. legal documents, medical records, etc.) to determine coverage for the claim and;

    · Independently examining Notice of Intent (NOI) and/or Complaint and analyze the allegations for claims exposure and;

    · Analyzing and reviewing each policy to determine applicable coverage as applied to the allegations identified in the NOI and/or Complaint and; 

    · Analyzing and applying the claims allegations to the restrictive language in the policy to determine coverage issues and; 

    · Independently determining coverage and document analysis of Reservation of Rights and/or Denials, as well as appropriate legal language to be used in correspondence to insureds

    30%  Conduct initial telephone interview with insured to glean important facts and pertinent details of claim exposure, providing counsel and accurate information to the insured during this stressful time, advising insured on claim reporting process and explaining next steps, discussing and explaining claims process with insureds, and providing guidance, comfort, reassurance, and support to the insured as situation warrants

    10% Provide consultation and advice on the company’s coverage disputes

    10% Recommend Claim File Type, Claims Specialist and Attorney assignments to Claims VPs and Directors

    10% Provide guidance and oversight to the Claims Set-up staff

    5% Review and finalize Reservation of Rights and Denial letters

    Secondary Duties:

    5% Provide guidance to operations for systems requirements and participate in UAT testing phase

    Qualifications and Requirements:

     Bachelor’s degree required with an Advanced degree or certification in the medical, legal or insurance field preferred. (i.e. current law student, Paralegal, R.N., J.D.)

     Proficiency in medical or legal terminology required

     Minimum two years’ professional capacity experience in a claims, medical, or legal office environment

     Proven leadership, excellent communication, and writing skills

     Strong interpersonal and relationship management expertise

     Proficient with Microsoft Office Suite 

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