Coverage Verification Specialist

Job Description

** This is an on-site position located in Roslyn, NY. **

General

Summary:

This position assists and supports the underwriting function by ensuring requests for claims histories and/or coverage verifications for all lines of business are provided timely and accurately, as well as other duties as requested.

Important Note: The Coverage Verification Specialist role is a temporary-to-hire employment opportunity. During the three-month trial period, skills, performance, and compatibility with the organization will be evaluated. If both parties find the role suitable after this period, an offer may be extended for regular full-time employment as an Coverage Verification Specialist.

Essential Duties & Responsibilities:

• Process requests for claims histories and/or coverage verifications from brokers, insureds or third parties
• Review requests for completeness, including proper authorization from insured(s), and request additional information needed; search providers in eOasis CIS and determine all applicable policy types
• Inform Account Manager of loss run requests when appropriate
• Prepare and send claims history and/or coverage verification reports within 5 days of request received
• Generate SAP report for Physician and Healthcare Facility policies as requested
• Prepare reports manually for Healthcare Facility policies, adding data retrieved from eOasis regarding policy coverage and claims; follow guidelines for certain hospitals/facilities prior to providing information
• Send reports via email to requestors; include original request and authorization document (if applicable)
• Enter data regarding requests for Physician policies in the Diary in eOasis
• Upload e-mail with reports to OnBase and/or corresponding Healthcare Facility files.
• Answer calls regarding COIs and Dec pages, both from automated prompts and operator
• Process requests for copies of COIs and Dec pages; send documents to insureds electronically
• Issue all new COIs to hospitals and facilities at insureds’ requests
• Add COIs to insureds’ policies as requested via eServices or e‑mail; provide electronic copies to insureds
• Enter data received for electronic delivery of COIs to Certificate Holders into eOasis
• Assist with sorting of incoming mail
• Responsible for weekly/monthly mass mailings of renewal declarations pages, COIs and other projects
• Maintain highest level of customer service and produce accurate work
• Understand and achieve productivity requirements to meet underwriting objectives
• Respond in a timely and professional manner to internal and external queries and requests received from our brokers and clients regarding requests
• Demonstrate a sense of urgency and consistently meet processing deadlines per underwriting service standards
• Other duties as assigned by management

Education & Qualifications
:

• Associate degree and minimum of 2-3 years office related experience required. Customer service background preferred
• Must be proficient in Microsoft Office Suite
• Participate in assigned projects and departmental efforts as an active and positive team member
• Must demonstrate ability to maintain an effective working relationship with other departments, employees, management and clients
• Excellent verbal and written communication skills
• Must be detail oriented and have good organizational skills
• Ability to work without direct supervision, make independent decisions and meet specific deadlines

The actual compensation for this position will be determined by experience and other factors permitted by law.