Trinity Health Claims Technician in Columbus, Ohio
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 GroupWise 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 updates file storage log.
Independently maintains and updates claim procedure manual and training plans.
Maintains and updates claim portion of IRMS website.
Maintains and updates unit shared drive.
Independently creates and implements orientation plan for new claim assistants; participates in orientation of new claim personnel.
Assists in preparing Power Point presentations for Trinity Health Leadership, MOs and/or outside counsel.
Acts as notary for IRMS personnel and notarizes documents as required.
Coordinates meetings, conferences, webinars and seminars for large groups including creating and distributing notifications, tracking responses and all other applicable duties associated with presentations made to large groups, in person as well as in electronic format.
Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
Must possess a comprehensive knowledge of liability claims processing and administration. High school diploma plus a minimum of five (5) years related work experience. Experience as a paralegal, legal secretary or an executive level assistant in insurance industry and additional academic training in other general undergraduate study.
Proficiency in medical and/or legal terminology.
Must possess ability and willingness to plan, organize and accomplish tasks accurately, efficiently and in a timely manner for multiple team members.
Strong verbal and written communication skills and the ability to effectively listen discuss and respond to inquiries and requests.
Must possess proficiency with office information systems, e-mail, fax and other standard Desktop applications. Proficiency in use of IRMS STARS system. PowerPoint, Excel, GroupWise, Word and Visio familiarity.
Must possess strong telephone skills and be proficient in the operating of telecommunication equipment. Proficiency in transcription typing and document formatting.
Basic knowledge of webinar processes and the skill necessary to plan and conduct mass electronic sessions is preferred.
Must be results and action-oriented, attentive to detail, use good judgment, and demonstrate respect for others.
Must possess ability to function in a dynamic, multi-task environment, be able to cope effectively with ambiguity and change.
Must be comfortable operating in a collaborative shared-leadership environment.
Must possess a personal presence that is characterized by a sense of honesty, integrity and caring, with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals and values of Trinity Health.
PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS
Must be able to set and organize own work priorities, and adapt to frequently changing priorities.
Must be able to travel to the various Trinity Health sites or other related locations as assigned, i.e., court, attorney offices (less than 3%).
Moderate physical activity, lifting and bending is required.
Job Number: 00106637
Location: Columbus, OH
Organization Name: Trinity Health
Facility: MCHS - Mount Carmel East
Employment Type: Full time
Shift: Day Shift