Claims Specialist

• Set-up and process new accounts daily
• Use company systems and technologies to enter content information and verify information received
• Communicate with patients, attorneys, and insurance carriers
• Establish and maintain positive working relationships with internal and external partners
• Ensure accurate and efficient coordination of motor vehicle claim accounts
• Problem-solve while handling complex, high-volume work in a team environment
• Maintain accountability, confidentiality, HIPAA compliance, and professionalism when handling medical and financial information
• Support the Compliance Program by adhering to policies and procedures, attending required training, notifying management of compliance concerns, and handling patient information appropriately

Entry Level Claims Analyst – Motor Vehicle Accident

• Submit orthodontic claims accurately and on time
• Resolve rejected and denied claims
• Research missing payments and process adjustments
• Conduct account audits and manage escalation cases
• Track and recover missing payments
• Use sFax, Adobe, PureCloud, and JIRA to improve workflow efficiency and collaboration
• Take ownership of professional development and skill enhancement
• Build cross-functional relationships across OrthoFi departments

Claims Coordinator

• Independently resolve large and significantly complex claims by investigating losses and negotiating settlements
• Determine insurance coverage by examining claim forms, policies, records, and evidence; interviewing claimants, injured workers, insureds, and witnesses; reviewing police and hospital records; and consulting experts
• Determine carrier liability and settle claims according to policy provisions and authority levels
• Handle mediations, arbitrations, subrogation, and litigated files
• Mentor and train claims representatives, shared claims staff, and interns
• Provide after-hours claims emergency support when on call
• Collect, analyze, and summarize claim information and recommend reserve changes and future file handling
• Investigate questionable claims and compare claims information with evidence
• Recommend litigation and evaluate negotiated settlement options and evidence
• Manage higher-exposure and highly complex claim files
• Oversee independent adjusters and attorneys to ensure company guidelines and procedures are followed
• Prepare reports and ensure proper file documentation in accordance with claims guidelines and state requirements
• Participate on catastrophe teams, determine department investigation guidelines, provide underwriting feedback, build agent relationships, and help select vendors
• Maintain professional and technical knowledge through training and continuing education
• Research state statutes, laws, regulations, case law, technical bulletins, and jurisdictional changes
• Communicate changes and impacts to claims handling with Claims Managers, Senior Quality Specialists, and the Claims Director
• Analyze business processes and workflows, recommend compliance improvements, and streamline processes
• Collaborate with Claims leadership on training and facilitate state meetings
• Troubleshoot workers' compensation vendor issues with Claims Vendor Managers and Claims Managers
• Assist with state interest credit, penalties, physician panels, annual state reporting, and compliance reviews
• Update state materials on the Claims Insider/SharePoint site and communicate updates to staff

Claims Specialist jobs in Colorado

Entry Level Claims Analyst – Motor Vehicle Accident

Claims Coordinator

Senior Claims Representative, Analyst