Insurance Operations Support Associate

Supports members of the Insurance Operations Department by completing a variety of day-to-day processing activities including transaction coding, data entry policy related activities and associated tasks within service level guidelines.  Demonstrates a superior level of customer service and ability to produce timely high quality work.

Essential Functions

• Conducts day-to-day processing activities, including data entry, notes, attaching documentation and associated tasks, in accordance with standard operating procedures, to assist the Claims Analysts and Litigation Managers.
• New Claim notice processing and associated tasks including First Notice of Loss, Additional Notice of Loss, Acknowledgement Letters, and Coverage Analysis Reiterations.
• Perform data searches (locate notices in system, identify proper work matters for correspondence, find vendors, find claimants) as part of daily assignments in the systems and locations for which they have been trained.
• Review, identify and process incoming correspondence.
• Complete Vendor setups including obtaining W9 and banking information from vendors.
• Conducts initial review and setup of legal defense and medical invoices.
• Process financial transactions including reallocations, bulk payments, and recoveries.
• Assists in collecting and reviewing materials related to implicated insurance coverage during the intake process.
• Medicare processing of Form B's including claimant entry into ClaimCenter and submission of initial inquiries to ExamWorks.
• Policy data review and setup including policy changes.
• Conducts complex policy research utilizing multiple databases, systems and historical records.
• Assists management with data tracking and data cleanup.
• Review of policy documentation loaded to the repository to ensure accuracy and quality.
• Communicate with various accounts receivable offices, outside counsel or other outside parties to resolve issues on expense or medical bills.
• Assist with Data Migration efforts, as needed.
• Assists with managing Declaratory Judgement service of process from intake to retention of counsel.
• Assists with receipt and review of all service of process, background research and sets up in claim and litigation systems.
• Assists with administration of litigation holds, conflict checks and retention of counsel
• Assists with managing legal documents, contracts, and settlement agreements.
• Assists with regulatory and corporate reporting.
• Maintains and updates counsel rates.
• Manages Subpoenas / requests for documents service of process, including validation, historical file research, redacting and communication with requesting party.
• Acts as point person for Acuity [billing system], manual billing and TPA billing process.
• Serve on Companywide committees and projects, as assigned.
• Drafts correspondence utilizing approved templates.
• Communicates with both internal and external customers on a regular basis.
• Consistently delivers superior customer service to both internal and external business partners.
• Develops creative ideas and solutions to real time business problems and /or business opportunities; takes reasonable, calculated risks even if failure is possible.
• Empowered to make decisions within job descriptions and authority. Seeks guidance where appropriate.
• Empowers self and teammates to continuously improve RiverStone’s business processes/systems and develops and escalates ideas and solutions.
• Seeks continuous development by identifying areas for growth and improvement. Works with the continuous improvement team to implement process and technical improvements.
• Understands Key Performance Indicators and manages towards those priorities.

• Required Skills

• Customer service oriented with the ability for developing long lasting relationships with internal and external business partners.
• Must be able to handle multiple assignments and prioritize appropriately.
• Computer skills in Word, Excel, Access and PowerPoint preferred.
• Must have excellent organizational skills.
• Capable of working independently with little close supervision and meeting assigned deadlines.
• Able to work accurately with financial data.
• Able to rapidly learn complex procedures, and company guidelines.
• Exhibits flexibility in assisting managers in various initiatives.
• Demonstrates discretion in handling confidential/sensitive information.
• Ability to align with and behave in accordance with RiverStone commitments and culture.
• Ability to process and search multiple systems.
• Must have the ability to read and understand legal complaints and filings.
• Written communication - attention to detail around grammar, punctuation and sentence structure.
• Ability to work effectively in a team environment.
• Ability to learn and adapt to various external systems for claim and invoice processing.
• Ability to input data with accuracy and precision.
• Ability to read and understand insurance policy forms and declarations.
• Ability to communicate with all levels within the Organization.
• Demonstrates ability and flexibility in a dynamic environment.

• Organizational

• Demonstrates alignment with RiverStone’s Commitments.
• Prioritizes and organizes work in self-directed manner.
• Attains and maintains knowledge of assigned department.
• Performs other duties as required, including supporting and coordinating with other department colleagues.