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Supplemental Sr. Claims Adjuster, Central Staffing


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Location: Houston TX

Company Name: Memorial Hermann Health System

Occupational Category: 13-1031.00,Claims Adjusters, Examiners, and Investigators

Date Posted: 2020-02-12

Valid Through: 2020-03-13

Employment Type: FULL_TIME

Description:

Supplemental Sr. Claims Adjuster, Central Staffing
• Job Type: Full-Time, Part-Time
• Job Level: Entry - Senior
• Travel: Varies by role
Location 7500 Beechnut,Houston,TX 77074 Facility Southwest Medical Plaza 3 Category Non-Clinical Professional Type Part time Requisition 100093491

At Memorial Hermann, we’re about creating exceptional experiences for both our patients and our employees. Our goal is to provide opportunities for our diverse employee population that develop and grow careers in a team-oriented environment focused on patient care.

Every employee, at every level, begins their journey at Memorial Hermann learning about the history of the organization and its established culture built on trust and integrity. Our employees drive this culture, and we want you to be a part of it.

Job Summary

The Supplemental Senior Claims Adjuster is responsible for investigating, evaluating and resolving more complex claims in order to achieve the best outcomes. They will be responsible to administer and resolve claims in a timely manner in accordance with legal statues, best practices and company guidelines.

As a Supplemental Senior Claims Adjuster, they will serve as a mentor, will develop and train all staff in the Claims Adjuster role.

Job Description

Minimum Qualifications

Education: Bachelor's degree in Business, Finance or related field; in lieu of degree four (4) or more years of equivalent work experience in an insurance related industry required

Licenses/Certifications
• Current unrestricted Texas All Lines Adjuster license; Associate in Claims (AIC) Designation
• or similar professional designation desired; and/or five (5 )years of experience as a license adjuster

Experience / Knowledge / Skills
• A minimum of six (6) years of experience handling non-subscription claims in Texas
• Strong knowledge of medical terminology is required
• Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously
• Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details
• Strong verbal, written communication skills and customer service skills gained through previous work experience
• Knowledgeable and able to comply with all relevant laws, rules regulations and accreditation standards and requirement
• Strong computer literacy, including working knowledge of MS Office Product Suite, i.e. WORD, Excel, PowerPoint
• Ability to respond to accidents on weekends, evenings, or at unexpected time
• Ability to travel for business purposes, up to 25% of the time (Houston metro area only)
• Demonstrates commitment to the Partners-in-Caring process by integrating both Behaviors and Operating Principles in all internal and external customer interactions. Performs duties with accountability, competency, innovation, collaboration, compassion and respect to create the best possible outcomes with exceptional customer experiences.

Principal Accountabilities
• Promptly investigates all assigned claims including field investigations with minimal supervision, including those of a more complex nature and highest exposures.
• Determines coverage, compensability, potential for subrogation recovery.
• Alerts management to potentially suspect claims.
• Ensures timely denial or payment of benefits in accordance with jurisdictional requirements.
• Within granted authority, establishes appropriate reserves with documented rationale, maintains and adjusts reserves over the life of the claim to reflect changes in exposure.
• Processes claims settlements within granted authority.
• Establishes and implements appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition.
• Works collaboratively with legal counsel, nurse case manager, return to work manager and other professionals to develop and execute return to work strategies.
• Maintains a working knowledge of jurisdictional requirements and applicable case law
• Demonstrates technical proficiency through timely, consistent execution of best claim practices
• Communicates effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues.
• Provides a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions.
• Authorizes treatment based on the practiced protocols established by statute or the medical guidelines.
• Serves and acts as internal subject matter expert and provide other claims adjuster team members training, mentorship and guidance.
• Responsible in handling the escalation of any issues or problems and complex claim situations.
• Oversees other claims adjusters with management of employee injury cases and with developing strategies to handle specific and complex cases.
• Communicate, collaborate and cooperate with internal and external stakeholders.
• Adheres to all Compliance/Program Integrity requirements.
• Complies with HIPAA Regulations
• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
• Other duties as assigned