REMOTE Claims Technician

Employment Type: Full time Shift: Day Shift Description:

** Position allows for remote/work from home.

** Must be able to travel to the various Trinity Health sites or other related locations assigned, i.e. court, attorney offices (less than 3%).

** Insurance experience is highly preferred, particularly if it was in claims.

** Any experience with state reporting requirements or hospital risk management would be a big plus.

Claim technicians are a vital component to the IRMS Liability Claims operation. The position is responsible for maintaining electronic claim files, coordinating claim process activities, opening and closing claim files, securing medical records for claims and incidents, tracking claim expenses and indemnity payments, providing loss run and other reports for both System Office and Ministry colleagues, assisting with data integrity and analytics, preparing state and federal reports, and providing administrative support to the Directors, Senior Area Claim Managers, Area Claim Managers, and Claim Specialists.

The claim technician is adept at navigating and using the Stars Enterprise database, the IRMS claim system.

Reviews and processes notices of loss and other claim information in UAIR and/or STARS database; enters claim information in database, establishes claim file numbers; sets initial reserves, creates diaries for management review, and creates paper claim files.

Selects and assigns appropriate carrier and policy number for each new file.

Maintains unit’s claim files; assures completeness of claim documentation, and determines and provides needed file information in a timely and efficient manner.

Coordinates Legal Hold process for each claim ensuring the information is captured in Stars; prepares and distributes Legal Hold notices to appropriate employees and TIS: retains electronic information in disk format; sends appropriate information to all necessary individuals at close of each file and assures appropriate destruction of electronic information.

Identifies claims to be closed, reviews file for completeness, processes claims for closure, inputs closing claim information into STARS database and processes closure of claims file.

Independently produces monthly summary claim reports and other template reports as requested.

Independently prepares and submits communication with excess carriers including notice of file opening and closing, notice of reserve increase, and removal from bordereau reporting.

Prepares and submits National Practitioner Databank reporting forms for review by ACM. (Not applicable for WC.)

Independently prepares and submits Insurance Coverage Review forms for all lines of coverage. (Not applicable for WC.)

Prepares and submits check requests with appropriate documentation at request of ACM; mails checks with explanatory correspondence. (Not applicable for WC.)

Reviews all incoming correspondence and places and revises diary dates in Group Wise and in STARS. Files correspondence and documents as appropriate.

Coordinates and assists with Internal Claim Review; coordinates, schedules, and prepares material for Block Reviews.

Contacts defense counsel as directed by ACM or Workers’ Compensation Claims Manager; composes correspondence/mail and form letters as directed; transcribes dictation and processes as directed.

Completes medical record request form and obtains medical records as directed by ACM; coordinates copying and distribution of records as appropriate. (Not applicable for WC.)

Independently coordinates claim unit’s office functions, activities and work schedules to ensure appropriate staff coverage, timely work completion, and effective communication.

Coordinates all aspects of travel arrangements for ACMs or WC Claims Managers, including scheduling and travel changes, as needed. Performs other claims support functions as assigned by Area Claims Manager such as scheduling, calendar management, and expense tracking.

Reviews and edits STARS data integrity reports as appropriate.

Independently coordinates file audits with internal and external auditors; prepares file for review.

Independently coordinates file retention, purge, storage and retrieval; maintains and…