Risk Management-Claims Processing Specialist

$37,440 - $38,709/Yr

City of McAllen - McAllen, TX

Full-time

McAllen, TX

Amusement, Gambling, and Recreation Industries

About the position

The Claims Processing Specialist at the City of McAllen operates under general supervision and procedural control, focusing on specialized claims work related to the processing and mitigation of workers' compensation claims, as well as property and casualty claims. This role involves the preparation of claims data for time-sensitive submissions into various claim portals, verifying claims information, gathering data, and assembling the necessary information and facts regarding claims workflow. The specialist is responsible for effective communication with both internal and external customers to facilitate the progress of all claims, as well as the preparation of various reports related to claims management. Additionally, the employee maintains both electronic and manual file systems, ensuring that all records are organized and accessible. The position requires the employee to plan their own workflow and use independent judgment in collecting and processing claims-related data. The specialist is responsible for the prompt and accurate submission of all workers' compensation and property and casualty claims, with decisions guided by existing state regulations and policies. The role also includes specialized claims work involving the mitigation and processing of claims onto various claim portals, as well as the review and submission of property and casualty claims. The employee assists in preparing various claims reports necessary for the review and management of claims, communicates with internal departments to obtain timely work status reports, and assists in verifying injury on the job leave when necessary. Moreover, the Claims Processing Specialist collects statistical data from quality assurance reviews, verifies and corrects data, and responds to inquiries in a professional manner, providing accurate public information about services while maintaining confidentiality. The role also involves processing, distributing, and filing information, maintaining records accurately, and providing information to customers on procedures while resolving routine concerns diplomatically. The employee may also diary appointments, maintain a calendar, and assist in preparing agendas, correspondence, or reports as assigned. Other related duties may be assigned as necessary.

Responsibilities

• Plans own work flow and uses independent judgment in the collection and processing of claims related data.
• Responsible for prompt and accurate submission of all worker's compensation and property and casualty claims; decisions are guided by existing state regulations and policies.
• Performs specialized claims work involving the mitigation and processing of worker's compensation claims onto various claim portals.
• Performs specialized claims work in the review and submission of all property and casualty claims; utilizes a claims portal for management of said claims.
• Assists in the preparation of various claims reports necessary for the review and management of claims for both worker's compensation and property and casualty.
• Communicates with internal departments to obtain timely work status reports and assists department in the verification of injury on the job leave when necessary.
• Communicates with internal/external claims adjusters to ensure appropriate claims workflow and mitigation; occasionally assists network medical providers in providing necessary claims information, and/or appointment compliance.
• Collects statistical data from quality assurance reviews and assists in compilation of data; verifies, proofreads and corrects data, records and forms when required.
• Responds to inquiries in a professional manner, providing accurate public information about services without disclosing confidential or unauthorized information.
• Processes, distributes, and files information, records, forms, documents and other information; maintains electronic and manual records, and files accurately and in an orderly manner.
• Provides information to internal/external customers on procedures and resolves routine concerns in a diplomatic manner.
• Diaries appointments and maintains a calendar; assists in the preparation of agendas, correspondence or reports as assigned.
• Performs other related duties as assigned.

Requirements

• Accredited high school diploma or GED equivalent and two (2) years (48 credit hours) of advance study or training past the high school equivalency, or five (5) years of related work experience in lieu of formal education requirement.
• Two (2) years of claims processing work experience.
• Current, valid Texas Class C driver's license.
• Attention to detail and exceptional organizational skills.
• Advanced computer skills and proficiency with Microsoft Word, Excel, PowerPoint, and other Microsoft Office tools.
• Ability to interact with internal and external customers in a professional and diplomatic manner.
• Effective communication skills in English and Spanish.