Claims Payment Specialist

<strong>AF Group (Lansing, Mich.) and its subsidiaries are a premier provider of innovative insurance solutions. Insurance policies may be issued by any of the following companies within AF Group: Accident Fund Insurance Company of America, Accident Fund National Insurance Company, Accident Fund General Insurance Company, United Wisconsin Insurance Company, Third Coast Insurance Company, or CompWest Insurance Company.</strong>

Lansing, USA

AF Group

<p class="p1"><strong>AF Group&rsquo;s focused and passionate team uses industry-leading best practices, analytics and resources to manage risk and minimize loss for our policyholders while strengthening businesses with our valued independent agent partners.</strong></p> <p class="p1"><strong>We strive to continuously increase the long-term value of our organization by outperforming our industry peers and fostering a culture of underwriting and claims excellence.</strong></p>

keywords: job description,work environment,analysis,claims,other duties,education & experience,knowledge,skills,preferred


Competitive Compensation and Benefits Package

Overview: <br />Responsible for all of the following duties Enterprise wide; Analysis and entry of detailed payment data into the claim system for all states including manual states, contact with employers to obtain missing payment information or to clarify information submitted, issuance of non-indemnity and non-medical payments, and manual payments, processing of refunds and transfers, handling route back checks for distribution, posting manual payments, research and resolution of returned non-medical checks. Contacts include agents, policyholders, claimants, attorneys, and other Claims Department and Service Center staff.<br /><br /><br /> <p><strong>WORKING CONDITIONS:</strong></p> <p>Work is performed in an office setting with no unusual hazards.&nbsp;</p> <p><strong>REQUIRED TESTING:&nbsp;</strong></p> <p><strong>Claims Payment Specialist:&nbsp;</strong>Basic Windows, Basic Excel, Basic Word, Reading Comprehension, Alpha Numeric, 10-Key, Math, Proofreading.</p>
Responsibilities: <br /> <ul> <li>Review payment requests to ensure compliance with the Workers Compensation regulations.</li> <li>Contact policyholder for payment clarification and to obtain necessary information.</li> <li>Verifies, calculates, and pays approved injured worker travel and miscellaneous expenses.</li> <li>Stops and voids payment checks as requested.</li> <li>Sorts and distributes checks as requested.</li> <li>Validates, investigates, and completes refund and transfer documents.</li> <li>Analyzes, validates, approves, and processes attorney, legal, IME, vocational rehabilitation, medical management, and all other vendor invoices.</li> <li>Contacts agents, policyholders, and injured workers to verify or gather claim information.</li> <li>Prepares form letters and composes general correspondence.</li> <li>Alerts Claim Handlers on reserve deficiencies.</li> <li>Participates in projects as requested.</li> <li>Post Excess &amp; TPA Payments to claim files.</li> <li>Post internal claim costs.</li> <li>Post manual payments.</li> <li>Provides assistance as a Subject Matter Expert for procedures and workflow documentation.</li> <li>Prepares form letters and composes general correspondence.</li> </ul>
Requirements: <br /> <p><strong>EDUCATION REQUIRED:&nbsp;</strong></p> <ul> <li>High School Diploma or G.E.D.&nbsp;</li> <li>Advanced training or college-level coursework in business, accounting, or insurance.&nbsp;&nbsp;</li> <li>Combination of education and experience may be considered in lieu of additional training or coursework.</li> </ul> <br /> <p><strong>EXPERIENCE REQUIRED:&nbsp;</strong></p> <ul> <li>Two years general office experience performing relevant duties that provide the necessary skills, knowledge, and abilities.</li> </ul> <p><strong><br /><br />SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:&nbsp;</strong></p> <p><strong>Claims Payment Specialist:</strong></p> <ul> <li>Basic knowledge of computers and spreadsheet software with data entry ability.</li> <li>Basic knowledge of Word Processing software.</li> <li>Excellent organizational skills and ability to prioritize work to meet established deadlines.</li> <li>Math skills with the ability to use a ten-key calculator.</li> <li>Demonstrated ability to proofread correspondence for accuracy of spelling, grammar, punctuation, and format.</li> <li>Excellent verbal and written communication skills.</li> <li>Demonstrated ability to manage work with minimal direction.</li> <li>Demonstrated ability to be an independent thinker to solve issues.</li> <li>Ability to enter alpha-numeric data accurately.</li> <li>Ability to verify data for accuracy.</li> </ul> <p><strong><br />ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE, AND/OR ABILITIES PREFERRED:</strong></p> <ul> <li>Additional training, work experience, or course work in workers compensation, insurance, or accounting.</li> <li>Insurance Institute of America Certification (IIA certification).</li> <li>Experience using a document management system with workflows.</li> <li>Workers&rsquo; Compensation Experience.</li> </ul>