Assistant Claims Representative

Job Title: Assistant Claims Representative

Type: Contract to hire 

Start Date: ASAP 

Duration: Ongoing 

Location: Roslyn NY 

Pay Rate - $27/hour


General Summary: Responsible for initial contact and creation of a claim file(s); assist the assigned Claim Representative with all aspects of maintaining a claim file from inception to disposition/closing of the file. 


Essential Duties & Responsibilities:

· Accept incoming calls and assist Insured (s) who are calling about a claim, incident, or summons. Obtain all pertinent information from Insured (s) regarding the service of legal papers and medical data involved.

· Establish a claim file when appropriate for reported claims to include but not limited to; verifying coverage before opening a new file, obtaining legal papers and/or medical records appropriate to the claim, assigning defense counsel, if appropriate, and sending necessary documentation, prepare reinsurance report when appropriate and complete all necessary forms and documents neatly, legibly and thoroughly.

· Establish a claim file in the computer system.

· Document all occurrences in the file by memo or written dated diary notes; varying from 20 + per day

· Assigned to a minimum of 4 Claim Representatives representing a caseload of approximately 500

· Interact with most departments in Company, Underwriting, Legal & Accounting Departments, through the life of the files.

· Arrange for in-house expert review at the direction of the Claims Representative: Prepare medical record(s), follow up for expert report(s) to insure timely receipt following department process, and keep Claim Representative informed of any related issues.

· Follow criteria established for reporting losses to reinsurers.

· Close all claim files, at the direction of the Claims Representative, by following department procedure.

· Close files when the statute of limitations has expired on cases not in a suit, at the direction of the Claims Representative.

· Obtain signatures and check requisition for all indemnity payments.

· Prepare excess carrier reports at the direction of the Claims Representative.

· Verify and approve all non-legal bills for payment and review and maintain adequate ALAE reserves including form documents.

· Responsible for scheduling all Conferences which include Claims Staff, Defense Attorney, Experts, Board Members, and Insured Risk Manager; enter on Claims Calendar and update with any scheduling changes, and obtain confirmation from all invitees.

· Prepare check requisition for all Indemnity payments, complete necessary documents i.e. create check batch, letters to insureds, attorneys, and accounting; close file.

· Update the database on a daily basis as changes occur and verify the accuracy of same; at least 20 per day.


Education & Qualifications:

· Recent grad from the Sciences or High school degree with 3 years related office experience in the following areas; Hospital, MD office, and/or insurance

· Knowledge of medical terminology is helpful

· Experience with Microsoft Suite required

· Excellent written and verbal communication skills required, prior customer service experience preferred, strong on the phone

· Ability to function in a fast-paced, demanding environment while adhering to various time-sensitive deadlines

· Ability to work independently and use good judgment

· Strong organizational skills; ability to multi-task and prioritize tasks and deadlines

· Ability to work with varied personalities and department employees

· Ability to maintain a cooperative, courteous, and professional relationship while speaking with insureds and claims personnel

· Ability to maintain a high degree of confidentiality, especially regarding information in files

· Must have good organizational skills and be detail-oriented

· Ability to function in a professional office environment and utilize standard office equipment.