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Claims Coordinator
The Claims Coordinator is responsible for managing and organizing the claims process to ensure accurate, efficient, and timely resolution of insurance claims. This role involves serving as a central point of communication between claimants, insurance providers, and internal teams, as well as maintaining records, monitoring claim statuses, and facilitating resolutions. The Claims Coordinator plays a vital role in streamlining operations and ensuring customer satisfaction by ensuring claims are handled in a professional and compliant manner.
Class Code:
PCA01P
Job Grade:
SGS07
Special Job Requirements:
Typical Functions:
Coordinate the entire claims process, from initial reporting to resolution, ensuring efficiency and accuracy. Serve as the primary liaison between claimants, insurance adjusters, healthcare providers, legal teams, and internal personnel. Review and verify claim documentation for completeness and compliance with policy terms. Monitor claim statuses and maintain up-to-date records in claims management systems. Investigate claim details, identify discrepancies, and resolve issues in collaboration with a variety of assorted personnel. Communicate updates and outcomes of claims to relevant parties in a clear and timely manner. Assist in developing and implementing process improvements for better claims handling. Ensure adherence to agency policies, industry standards, and regulatory requirements. Prepare reports and summaries on claims data and trends for management review.
Knowledge, Abilities, and Skills:
Strong organizational and multitasking abilities. Excellent verbal and written communication skills for interacting with a variety of assorted personnel. Attention to detail and the ability to analyze and resolve discrepancies. Knowledge of insurance policies and regulations is advantageous. A customer-focused and problem-solving mindset is essential.
Minimum Qualifications:
Bachelor’s degree in business administration, insurance, healthcare administration, or a related field. Minimum of 4 years of experience in claims coordination, claims management, customer service, or related fields. Satisfaction of the minimum qualifications, including years of experience and service, does not entitle employees to automatic progression within the job series. Promotion to the next classification level is at the discretion of the department and the Office of Personnel Management, taking into consideration the employee’s demonstrated skills, competencies, performance, workload responsibilities, and organizational needs.
Required Certificates:
N/A OTHER JOB RELATED EDUCATION AND/OR EXPERIENCE MAY BE SUBSTITUTED FOR ALL OR PART OF THESE BASIC REQUIREMENTS, EXCEPT FOR CERTIFICATION OR LICENSURE REQUIREMENTS, UPON APPROVAL OF THE QUALIFICATIONS REVIEW COMMITTEE.
Exempt:
N