Program Claims Assistant II

The Program Claim Assistant II has demonstrated Claims support and exhibits capabilities of learning additional tasks and responsibilities. The Program Claim Assistant II assists the Program Claim Team (VP Directors PCMs CXMs Quality Specialists) MGAs and TPAs by performing a variety of support services. The position has some oversight by the supervisor to support the Claim Assistant II. The Claim Assistant II maintains a solid understanding of AmTrusts mission vision and values. Upholds the standards of the AmTrust and Claims organization.

some oversight from Supervisor:

Participate in TPA due diligence process and documentation

Manages reports (NCCI Medicare $0 Reserve) including TPA notification confirmation of corrections and tracking

Maintain SharePoint site

Manage multiple general mailboxes (AUI WC & Liability Notification)

Onboarding and quarterly validation of TPA users

Performs financial activities to include but not limited to TPA/Vendor payment in Oracle issuing claim payments requests for stop pays voids and check copies.

Works directly with CXM to enhance customer service by managing system access and generating reports.

Receives and/or returns telephone calls and emails as directed by team.

Requests file copies for various services to include but not limited to medical legal recovery and subpoena responses.

Coordinates and handles mailing requests to include but not limited to standard overnights and certified/return receipts.

Completes claim assignments/bulk assignments as needed.

Generate and maintain various reports to support the program team.

2. Ensures quality and timely service is provided to all whether directly or indirectly interacting with customers.

3. Uses critical thinking and decision-making skills to gather assess analyze question verify interpret and understand key or root issues.

4. Exhibits understanding and applies knowledge of technical processes order to deliver a quality product to stakeholders and business partners.

5. Performs tasks as assigned with a limited error rate.

6. Establishes and maintains effective relationships with customers gains their respect and trust.

7. Adheres to any compliance changes as directed by your supervisor.

8. Keeps current with market trends and demands.

9. Performs other functionally related duties as assigned.

10. May be required to work overtime as assigned.

• High School diploma
• Strong knowledge of claim procedures and policies
• Ability to take direction and make sound business decisions
• Self-motivated and detail oriented
• Ability to adapt to a changing environment
• Professional telephone demeanor and strong oral and written communication skills
• Ability to work well under pressure and multi-task in a fast-paced environment
• Moderate understanding of business technology and MS Office
• Ability to work in a team environment

Preferred:

Some college

2 years of experience in a claims department or related experience

This job description is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities duties or responsibilities that will be required in this position. AmTrust has the right to revise this job description at any time.

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AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans Life Insurance including eligible spouses & children Health Care Flexible Spending Dependent Care 401k Savings Plans Paid Time Off.

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race ethnicity gender sexual orientation culture religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds skills and perspectives of its workforce it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative enabling us to attract retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company how we operate and how we see our future.