Claims Service Representative

  • Job Reference: 455053936-2
  • Date Posted: 23 December 2021
  • Recruiter: Pharmacists Mutual
  • Location: Burt, Iowa
  • Salary: On Application
  • Sector: Call Centre / Customer Service
  • Job Type: Permanent

Job Description

Pharmacists Mutual has an opening for a Claims Service Representative. This position is responsible for the first customer experience with claims.  The CSR handles administrative duties of the claims process such as; providing excellent phone communication skills, accurate entry of claim data, and serving our customers both internal and external.  

Claims Service Representative I

  • Entry level.

Claims Service Representative II

  • Works independently within established guidelines.
  • Completes projects as assigned.

Senior Claims Service Representative

  • This position includes the roles of a trainer, mentor, and coach to less experienced CSRs to increase their technical expertise.
  • Technical expert liaison between manager and other departments.
  • Analyze data and run reports to measure and identify trends to improve claims unit growth.
  • Oversight of training, implementation of new processes and ability to identify issues and resolve accordingly.

Essential Functions

Essential functions may include, but are not limited to the following:    

  • Talks with customers and claimants to collect and document claim information at first notice of loss.
  • Set up claim within claim system(s) and refers claims to specialized units to ensure timely contacts are achieved.
  • Processes indexing of tasks within claims system.
  • Maintains claim files and document claim file activities in accordance with established guidelines.
  • Monitors and responds to department communication and takes appropriate action.
  • Utilizes diary management system and documents appropriate notes.
  • Maintains and updates internal and external claim reports.
  • Monitors and audits outgoing claim checks.
  • Assists with other Claims Units as needed.

Knowledge, Skills and Abilities

  • Demonstrate empathy to those who suffered loss.
  • Ability and flexibility to work longer hours when workload fluctuations occur.
  • Research and stay up-to-date with trends and changes in the claims/insurance industry.
  • Communicate effectively with others (oral and written).
  • Analyze complex issues and make critical decisions.
  • Correct English usage, spelling, grammar, vocabulary and punctuation.
  • Maintain records, prepare reports and conduct correspondence related to the work.
  • Interpret and apply laws, rules and regulation, as well as complex policy and contract coverage.
  • Obtain and use sensitive information discreetly and objectively, both internal and external.
  • Determines when to escalate concerns to the appropriate level of management.
  • Follow oral and written directions.
  • Work effectively with others in a team environment.
  • Contribute effectively to the accomplishment of team or work unit goals, objectives and activities.
  • Establish and maintain effective working relationships with those contacted in the course of work.
  • Excellent customer service skills.
  • Ability to organize and prioritize work.
  • Work independently and demonstrate drive and initiative.
  • Ability to handle multiple tasks at once.
  • Ability to meet definite deadlines and deal with pressure situations.
  • Collect, interpret, and input data efficiently and accurately.
  • Use computer and related software effectively.
  • Use Microsoft Office programs efficiently and effectively. 

Experience and Education Qualifications

Claims Service Representative I

  • High School Diploma or equivalent and 1 year of related experience; or
  • Associate's Degree or equivalent 

Claims Service Representative II

  • High School Diploma or equivalent and 3 years of related experience; or
  • Associate's Degree or equivalent and 1 year of related experience 

Senior Claims Service Representative

  • High School Diploma or equivalent and 5 years of related experience; or
  • Associate's Degree or equivalent and 3 years of related experience; or
  • Bachelor's Degree 

Special Requirements, Licenses and Certificates

  • Education plan, special requirements and designations at manager's discretion.
  • Licensing may be required in some states.