Claims Analyst

The Claims Analyst is responsible for processing and adjudicating claims according to the coverage in the plan documents as well as any related duties or tasks accurately and in a timely manner while maintaining an acceptable productivity level as determined by the Director. Your responsibilities will include outbound claims communication with attorney providers, and inbound/outbound claims communication with Customer Service staff, Claims TPA, Underwriter and Carriers, including correspondence via phone and email. Responsibilities will also include assisting with claims intake/setup, sending closed claims statements and other duties as assigned. Translating policy language into claims authorization or denial language will also be a key part of this role.




Duties and responsibilities


Essential Functions

• Reviewing in-network claims submitted by attorneys within the LegalEASE provider network;
  
• Reviewing out-of-network claims submitted by members;
  
• Calculating coverage amounts accurately and efficiently minimizing errors and processing time;
  
• Following up with attorney network providers for additional required information or clarification as needed;
  
• Achieving internal goals for processing efficiencies set by management;
  
• Generating new ideas to improve current protocols and improve customer and provider satisfaction and service levels;
  
• Accepting personal responsibility for your tasks and actions in the claims department. Follow-through with contacts, claims, and other tasks assigned to you;
  
• Seeking appropriate assistance in completing a task or interpreting policy language if you are unsure of the procedure or protocol;
  
• Translating policy benefit language into claim authorization or denial language for clarity and consistency;
  
• Maintaining working knowledge of compliance requirements set by carriers for policy forms, claims and state requirements;
  
• Completing job requirements in a manner consistent with the core values of LegalEASE.
  
• Communicating efficiently with internal staff and external partners in response to all phone and email inquiries about claim-related questions in an acceptable time frame
  
• Maintain organized written and verbal communication with attorney providers;
  
• Document all claim activity and communication accurately and concisely in claim file;
  
• Maintain updated claims processing guidelines as new protocols are defined;
  
• Participates in internal and external quality audits;
  
• Maintains in-depth working knowledge of Legal Access Plans’ systems and processes;
  
• Keeping up with the renewals for the adjuster licenses(once obtained) to keep it current.
  
• Performs other related duties as assigned
  

Qualifications • College Degree preferred

• Must demonstrate sound judgement and decision-making in performing day to day activities
  
• Must have strong analytical and problem solving abilities
  
• Must plan work appropriately and balance multiple priorities
  
• Excellent communication skills, both written and verbal
  
• Must maintain the highest level of professionalism
  
• Strong working knowledge of Microsoft Office Suite especially MS Excel (used in quickly calculating coverage limits, discounts, etc. for EOB)
  
• Strong organizational skills;
  
• Strong attention to detail;
  
• Obtain Texas Insurance Adjuster License within 2 months
  
• Familiarity with Insurance concepts
  
• Working knowledge of attorney or legal industry billing practices
  
• Experience in legal or liability claims processing
  

Supervisory Responsibility


No direct reports. This is an individual contributor role within a close team environment.




Work Environment


This job operates in a clerical, office setting. This role routinely uses standard office equipment such as computers, phones, and fax machines.




Physical Demands


The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to speak or hear. The employee frequently is required to stand, walk, use hands to finger, handle or feel, and reach with hands and arms in addition to lifting items such as boxes of copy paper or similar as needed to perform daily work.




Position Type and Expected Hours of Work

This is a full-time position non-exempt overtime eligible

The basic expectation is 40-50hours worked per week.

Flexible work from home options available.