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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in claims processing functions and systems, with strong abilities in data analysis, problem-solving, and effective communication. Capable of training staff and managing multiple tasks efficiently while maintaining accurate records.
Highest-signal resume keywords
Claims Processing KnowledgeData AnalysisEffective CommunicationProblem-SolvingCustomer Service Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ConceptsClaims SystemsData Processing TechniquesTransaction ProcessingAuditing RecordsResearch SkillsAccount BalancingDocument ReviewFund AllocationGeneral Claims Training
Soft Skills
Organizational SkillsPrioritizationIndependenceTraining AbilityAttention to Detail
Tools & Technologies
P.C. Software ApplicationsAutomated Processing Systems
Certifications & Qualifications
High School Diploma or EquivalentValid Driver's License
Industry Keywords
Claims Processing PoliciesClaims ProceduresCustomer ServiceBusiness AdministrationComplex Problem Resolution
About the role
Key responsibilities & impact- Provide support to the Claim department using advanced knowledge of claims concepts, processes, organizational workflows, and claims systems
- Work independently with limited supervision on analysis, research, calculations, and synthesizing information from multiple sources
- Receive inbound and make outbound customer phone calls to resolve claims needs
- Review claim documents for accuracy and determine next process actions
- Train less senior staff on departmental processes and procedures
- Perform lower-level staff tasks when necessary
- Process paperwork for outgoing checks
- Investigate stop-pay requests for accuracy
- Allocate funds to the correct coverage in the appropriate claims system
- Review checks and resolve issues before funds are released to the state, including redepositing funds to avoid improper escheatment
- Research activity associated with positive-pay processes
- Research incoming checks, allocate them properly, and process deposits
- Balance accounts and resolve allocation issues
- Balance and reconcile all claim deposits
Requirements
What you’ll need- High School Diploma or equivalent OR three years of experience in processing, customer service or business administration
- Working with P.C. software applications
- Maintaining accurate files and records
- Identifying, investigating, and resolving complex problems
- Processing transactions and posting to appropriate accounts
- Organizing and prioritizing multiple tasks
- Effective oral and written communication
- Using automated processing and computer systems
- Gathering data and preparing reports
- Auditing records, products, and computer files
- Composing routine correspondence including letters and memos
- Knowledge of claim processing functions
- Knowledge of claim processing systems
- Knowledge of claim processing policies and procedures
- Knowledge of data processing techniques
- Knowledge of techniques used to audit data
- Ability to successfully complete General Claims Training
- Valid driver's license required if primary responsibilities involve in-person inspections or frequent in-person meetings with members
- Background and drug screen required upon offer
- Regular and reliable attendance is essential
Benefits
Comp & perks- Annual company bonus incentive
- Medical plans with multiple coverage options, including HSA eligibility
- Prescription drug coverage
- Dental and vision benefits
- Employee Assistance Program
- Company-paid basic life insurance
- Optional supplemental life insurance and dependent coverage
- Short-term and long-term disability coverage
- Critical illness, accident, and pet insurance options
- 401(k) plan with company match and additional company contribution
- Health Savings Account (HSA) and Flexible Spending Accounts (FSA)
- Paid Time Off (PTO), increasing with tenure
- 10 company-paid holidays annually for full-time employees
- 1 mental health day, 2 floating holidays, and 1 volunteer day for full-time employees
- Paid parental, bereavement, jury duty, and military leave
- Tuition assistance
- Professional certification support with 100% reimbursement for eligible programs
- Career development and advancement opportunities
- Complimentary AAA membership with roadside assistance and travel discounts
- Adoption assistance program
- Hybrid work arrangement
