The Policy Services Representative ensures timely and quality service to underwriters and agents by processing policy and customer service related documents and endorsements for commercial accounts within the service guidelines established. May participate in screening and quoting commercial accounts within the authority levels established.
- Provides timely and high quality service to agents through the processing of quotes, policies and other service related documents within time service and quality standards determined by management.
- Adapts and leverages new technology and innovation to manage a book of business based on business need while maintaining high standards of Client Service Infusion (CSI) through responsiveness and resourcefulness.
- Provides assistance to other Policy Services Representatives.
- Contributes to the team by accomplishing the Policy Services budgeted expense objectives and time service objectives. Provides ideas for and assists with the execution of improving current processes and procedures.
- Occasional travel to agency, company and other required meetings a must.
- Develops positive relationships with agencies through professional communication.
NC, Greensboro - 7823 National Service Road
Responsible for the management of medical only workers’ compensation claims.
- Maintain good lines of communication with employers, adjusters, and providers.
- Discuss with an employer, issues relative to an injured workers’ return to work status.
- Request medical notes, proper billing format and other written and verbal information from employers and medical providers to determine appropriateness of payment of medical bills and whether a claim is truly medical only.
- Timely and accurately reserve for medical only claims assigned.
- Document relevant written and oral communication received relative to medical-only claims in the log notes.
- Discuss with an employee, issues relative to whether a bill has been paid or whether travel or medical reimbursement has been issued.
- Assist in the management of communication of the unit with customers, providers and injured employees.
- Enter medical notes into claim log as required.
- Index images as needed.
- Identify potential subrogation claims and notify appropriate supervisor.
- Other duties as assigned by Supervisor.
NC, Charlotte - 2127 Ayrsley Town Blvd
NC, Greensboro - 7823 National Service Road
This position is responsible for reporting required data to applicable state insurance departments and/or rate bureaus per timeliness and quality expectations. Also includes research and resolving technical errors based on established reporting requirements, monitoring changes initiated by the states, and working with appropriate departments to adhere to the compliance/regulatory guidelines.
This position is part of a team that works with other stakeholders within the Company to: (i) identify and analyze state regulatory requirements and deadlines for reporting of insurance policy and claims data to various state regulators, (ii) prepare, validate and submit data files to state agencies, (iii) to investigate and correct errors in the data; and (iv) identify and implement process improvements.
This home-based position will be responsible for technical file management of workers’ compensation claims and account management. Requires frequent interaction with the account’s designated contact, case managers, medical providers, claimants and attorney. Will be required to manage a variety of cases ranging from minimal to high exposures.
- Assume responsibility for account management while working closely with CSE if assigned; recognize unfavorable trends and inform management.
- Participate in client meetings for training on claims issues and assist with claims service meetings for new accounts as requested.
- Analyze and work with Underwriting and Loss Control to develop pro-active plans to correct unfavorable trends with existing clients. Report to management, Underwriting and Loss Control unsuccessful attempts to reverse unfavorable actions and adverse conditions.
- Conduct the required investigation on all workers' compensation claims assigned.
- Handle all technical aspects of claims including coverage, disability benefit management, medical management, file management, litigation management, subrogation, reserving and settlement.
- Maintain and demonstrate knowledge of the Workers' Compensation Act and Rules and Regulations in the jurisdictions assigned.
- Immediately notify management of large exposures and comply with reinsurance reporting requirements.
- Monitor expenses and effectiveness of inside/outside vendors.
- Attend mediations.
- Attend client visits and claim reviews.
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