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Federated Rural Electric Insurance Exchange, the leading provider of property and casualty insurance for rural electric cooperatives in 45 states, is currently searching for a Insurance Claims Technician.

General Summary:

Set up new medical-only and lost time claims. Pays claims and keeps appropriate records. Assists Claims Service Representatives and Claims Service Assistant with claims process.

Essential Job Functions:

1. Promptly set up new medical only and lost time files in claims system and send acknowledgment letter or email to insured in timely manner advising of claim number.

2. Establish initial reserves on new claims and continue to monitor reserves based on expected outcome of claim.

3. Accurately enter indemnity, legal and medical checks into claims system. Enters voided, recovery and manual checks into computer system as appropriate. Matches printed checks to appropriate attachments and mails checks.

4. Assists Claims Service Rep & Claims Service Assistant with form completion and other aspects of claims process as requested.

5. Prepares, scans, and index correspondence, mail and medical bills into the imaging system.

6. Handles various claims questions, coverage questions and other inquiries via telephone. Develops correspondence to claimants, providers, physicians, etc. as appropriate.

7. Prepares claim denial letters and sends to appropriate parties.

8. Submits claim information electronically to the various states and to ISO

9. Assists Claims Service Rep with investigation of claim to determine compensability. Investigation may require interviewing claimants and witnesses.

10. Monitors file on diary system to ensure quick resolution and best possible outcome.

11. Recognizes files with subrogation potential and follow procedures to pursue reimbursement.

12. Participates in industry conferences, webinars and medical seminars.

13. Promptly and professionally reply to emails, faxes and written correspondence.

14. Identifies questionable claims and bring them to the attention of management for further handling instructions and possible reassignment to Claims Rep or Claims Service Assistant.

Direct Reports:

None

Knowledge, Skills, and Abilities:

• Basic knowledge of insurance claims process.
• Knowledge of medical terminology.
• Knowledge of mathematical principles and practices.
• Knowledge of company products, services, policies, and procedures.
• Knowledge of general office practices.
• Skill in oral and written communication.
• Skill in operating such office equipment as personal computer, Internet, e-mail, fax machine, copy machine, and claims software.
• Ability to communicate with co-workers and customers in a professional manner.
• Ability to maintain flexibility and responsiveness when faced with multiple work tasks and stressful situations.
• Ability to pay close attention to detail.
• Ability to maintain confidentiality.

Education and Experience:

High School diploma or equivalent, plus 1-year customer service experience. Previous insurance related experience and/or insurance related courses beneficial.

Physical Demands:

While performing the duties of this job, the employee is regularly required to use hands to finger and handle controls, talk and hear. The employee is frequently required to sit and reach with hands and arms. The employee is occasionally required to stand and walk. The employee must frequently lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, color vision, and the ability to adjust focus.

Working Conditions:

Normal office working environment with the absence of disagreeable conditions.

EEO Employer/Disabled/Protected Veteran