MMC Inc
Claims Representative - TPA Services
MMC Inc, Schaumburg, Illinois, us, 60159
This job was posted by https://illinoisjoblink.illinois.gov : For more information, please see: https://illinoisjoblink.illinois.gov/jobs/12368499 Marsh McLennan Agency\'s Midwest Region is a full-service brokerage providing business insurance, employee benefits, private client insurance, and retirement services to businesses and individuals across the country. MMA Midwest is consistently recognized as a top workplace, attracting and retaining its insurance talent by rewarding expertise and investing in career development. Colleagues enjoy an award-winning culture that fosters a highly productive and results-driven working environment.
The Claim Representative plays a key role in supporting the TPA Services by assisting with the coordination of communication between clients, claim examiner, re-insurers and the captive. They timely respond to questions asked by clients and internal teams, advising clients on reporting techniques and procedures, and managing claims through conclusion. Additionally, the Claim Representative supports the team\'s TPA Services through the resolution of claims.
Claims
Processes claim information from the client, makes appropriate policy verification and inputs claim information into the system Instructs insured on gathering proper claim information needed for claim reporting and inputs claims into the system Sets diaries to follow claim progress as needed, assigning to other team members appropriately Updates RMIS system claim notes, open/closure notices and monitors and maintains electronic filing systems Maintains a concern for timeliness and completeness when interacting with customers, agency teams and TPA staff to minimize potential for error and omission claims Communicates claims concerns, large claims or potential problems to appropriate Claims Representative or Claims Manager Completes Escrow funding requests, submits to reinsurer, ensuring funding is released so payments can be issued Oversees Medicare reporting and ensures any concerns are addressed Completes status reports on individual claims and prepares for presentation to client Assists in developing, training and updating of internal claim procedures, programs and processing Addresses and resolves client claim questions/problems Identifies PCEs (potentially compensable events) and escalates to Claims Examiner as appropriate Owns reporting compliance with state and other professional requirements Understands and follows TPA Services procedures
Execution of Client Service
Supports Claims Examiner and other internal department members to flawlessly execute MMA Midwest TPA Service\'s strategy for each client, designed to create measurable value and efficiencies in their businesses Processes changes, as needed or requested by the client, checking for consistency and documenting in the appropriate system Builds personalized client relationships through demonstrated understanding of the service plan and multiple channels of communication such as phone, email and in-person meetings Leverages insurance knowledge and communication skills to explain coverage terms and claims strategy Works with internal departments to ensure cohesiveness and timeliness of service execution Manages time effectively to prioritize workload, client service requests and service parameters on business processes
Data and Process Integrity
Maintains accurate and complete claim data in RMIS systems including policy detail, activities, attachments or anything in regard to claims Consistently achieves data integrity and meets activity timeliness, quality metrics and goals Follows processes and procedures in servicing workflow, maintaining appropriate and clear documentation of client and ven or conversations, taking appropriate action and following up as requested Completion of monthly reports; to include Loss Runs, Aggregate Reports and any specific reports as requested by client or claim examiner Completed reconciliation of claims payments at frequency requested by auditors or clients Utilizes internal resources for identified processes to ensure efficiency and consistency in execution
Peer Relationships
Provides feedback and shares information at team meetings Participates in ongoing scheduled meetings with Claims Team to discuss accounts, renewals, service needs, service platform, etc. Develops successful and effective working relationships with Producers, Account Executives, Account Managers, service team members, managers, carriers and members of other departments Communicates effectively with Claims Team members and provides timely and complete information to allow them to effectively manage service execution
Required
Knowledge of software systems, to include Excel
Preferred
BS/BA in Business, Insurance or related field Intermediate skill level in Microsoft Office Suite Adjuster licensing
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The Claim Representative plays a key role in supporting the TPA Services by assisting with the coordination of communication between clients, claim examiner, re-insurers and the captive. They timely respond to questions asked by clients and internal teams, advising clients on reporting techniques and procedures, and managing claims through conclusion. Additionally, the Claim Representative supports the team\'s TPA Services through the resolution of claims.
Claims
Processes claim information from the client, makes appropriate policy verification and inputs claim information into the system Instructs insured on gathering proper claim information needed for claim reporting and inputs claims into the system Sets diaries to follow claim progress as needed, assigning to other team members appropriately Updates RMIS system claim notes, open/closure notices and monitors and maintains electronic filing systems Maintains a concern for timeliness and completeness when interacting with customers, agency teams and TPA staff to minimize potential for error and omission claims Communicates claims concerns, large claims or potential problems to appropriate Claims Representative or Claims Manager Completes Escrow funding requests, submits to reinsurer, ensuring funding is released so payments can be issued Oversees Medicare reporting and ensures any concerns are addressed Completes status reports on individual claims and prepares for presentation to client Assists in developing, training and updating of internal claim procedures, programs and processing Addresses and resolves client claim questions/problems Identifies PCEs (potentially compensable events) and escalates to Claims Examiner as appropriate Owns reporting compliance with state and other professional requirements Understands and follows TPA Services procedures
Execution of Client Service
Supports Claims Examiner and other internal department members to flawlessly execute MMA Midwest TPA Service\'s strategy for each client, designed to create measurable value and efficiencies in their businesses Processes changes, as needed or requested by the client, checking for consistency and documenting in the appropriate system Builds personalized client relationships through demonstrated understanding of the service plan and multiple channels of communication such as phone, email and in-person meetings Leverages insurance knowledge and communication skills to explain coverage terms and claims strategy Works with internal departments to ensure cohesiveness and timeliness of service execution Manages time effectively to prioritize workload, client service requests and service parameters on business processes
Data and Process Integrity
Maintains accurate and complete claim data in RMIS systems including policy detail, activities, attachments or anything in regard to claims Consistently achieves data integrity and meets activity timeliness, quality metrics and goals Follows processes and procedures in servicing workflow, maintaining appropriate and clear documentation of client and ven or conversations, taking appropriate action and following up as requested Completion of monthly reports; to include Loss Runs, Aggregate Reports and any specific reports as requested by client or claim examiner Completed reconciliation of claims payments at frequency requested by auditors or clients Utilizes internal resources for identified processes to ensure efficiency and consistency in execution
Peer Relationships
Provides feedback and shares information at team meetings Participates in ongoing scheduled meetings with Claims Team to discuss accounts, renewals, service needs, service platform, etc. Develops successful and effective working relationships with Producers, Account Executives, Account Managers, service team members, managers, carriers and members of other departments Communicates effectively with Claims Team members and provides timely and complete information to allow them to effectively manage service execution
Required
Knowledge of software systems, to include Excel
Preferred
BS/BA in Business, Insurance or related field Intermediate skill level in Microsoft Office Suite Adjuster licensing
r