Claims Quality Audit Director jobs in Utica, NY

The responsibility of the team is to provide a supporting role for the Auto, Casualty and Property Claims divisions. Accuracy and timeliness of Support assignments have a direct impact on the claim experience and compliance with numerous insurance regulations.

Duties & Responsibilities:

• Filing
• Distribution of forms, letters, checks and reports.
• Process incoming mail/return mail.
• Mail all forms, letters, checks and transcriptions.
• Print as necessary from eDocs and websites.
• Assist appraisers and adjusters.
• Document Medicare file reviews and reporting information.
• Research problem mail.
• Generate simple checks (adjusting, tow bills, medical bills, salvage bills, etc.)
• Obtain claim check copies.
• Dictation/maintain transcript log.
• Monitor incoming phone calls.
• Order supplies.
• Set up claims.
• Appropriately document claim files, including entering draft payments into claim files.
• Rename and re-index documents.
• Process police report requests and update file upon return.
• Deposit salvage, review subro and salvage, tow, and glass checks.
• Process CD requests and Microfilm requests.
• Complete claims processes and transactions involving confidential and sensitive information.
• Responsible for all reinsurance support tasks.
• Review/process stale dated drafts/checks.
• Maintain DB on PACE, such as Providers.
• Process all tax levies.
• Research and process approved appraisal payments.
• Liability file set up.
• Loss set up AS400/coding.
• Complex PACE updates (DOL change, etc.).
• Access financial institutions (Stop pay).
• Moderate/Advanced database usage.
• Process more complex financial transactions, such as ROL and ROA.
• Issue any/all liability/subro payments.
• Process incoming mail/Process return mail.
• Mailing all forms, letters, checks and transcriptions.
• Maintain knowledge of Medicare reporting laws.
• Determine reportable injured parties through Medicare maintenance queues and provided reports.
• Pend medical bills, as needed, for further contact as necessary to obtain information.
• Research and correct any errors identified after the quarterly Medicare submissions are returned.
• Report BI settlements on all Medicare eligible claims.
• Meet monthly and quarterly filing requirements.
• Research problem mail.
• Review/analyze reports (Loss04, Loss25, Loss20 etc.)
• Review claim files, reports, and medical bills to obtain reportable details.
• Recheck claim file reports and forms as well as contact injured parties by letter and/or telephone to obtain missing or incorrect information.
• Perform ISO decision net search for social security numbers and/or date of birth.
• Effectively communicate and work with all Claims divisions as applicable.

Requirements:

• High School Diploma

Skills/Qualifications

• Understand the Medicare maintenance queues, actuate reports, and reports provided by analytics to aid in determining reportable injured parties.
• Good keyboarding and computer skills.
• Ability to work within a team.
• Attention to detail.
• Ability to follow established processes and instructions.
• Appropriate claim file documentation.
• Phone skills.
• Ability to multitask and prioritize.

Payband: 1/ 40 hours per week

Salary Range: $31,200- $35,787

Accepting applications until: 3/12/24