Claims Processor
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Job Description
Claims Processor overseeing medical records and wellness claims adjudication for Fetch pet insurance. Organizing documentation and providing administrative support for the Specialty Claims team.
Responsibilities:
- Documentation & Record Procurement: Conduct high-volume outbound calls to veterinary clinics to request missing medical records and documentation essential for claim adjudication. Review incoming emails and accurately upload documents to the associated policyholder accounts, ensuring all files are correctly categorized. Navigate difficult conversations with clinic staff, pivoting quickly to provide alternative identifiers when a patient is not easily found in their system.
- Claims Support & Wellness Adjudication: Review and assess wellness-specific claims, ensuring they meet policy guidelines for routine care and preventative services. Monitor administrative email queues to address requests from Adjusters and the Service Department regarding file status or account updates. Provide specialized administrative support for VIP accounts, ensuring high-priority requests are handled with precision and care.
- Operational Reporting & Special Projects: Monitor aging claim reports to identify files that require follow-up, ensuring claims remain within established processing timelines. Assist with side administrative projects, including moving files between accounts, managing tracking sheets, and supporting automation initiatives. Maintain and update Google Sheets or Excel trackers, utilizing sorting, filtering, and basic formulas to organize claims data.
Requirements:
- Strong Communication Skills: Exceptional verbal communication for frequent clinic outreach and professional written skills for internal and external correspondence.
- Technical Proficiency: Comfortable working within Google Suite; foundational skills in Google Sheets or Excel (sorting, filtering, and basic formula writing) are highly preferred.
- Problem-Solving & Investigation: Ability to "think on your feet" to resolve account issues, find missing files, and investigate request discrepancies.
- Organization & Multi-tasking: Proven ability to manage multiple administrative tasks simultaneously while maintaining high attention to detail.
- Adaptability: Capable of pivoting quickly between different tasks, from phone outreach to data entry and special project support.
- Remote Environment: Ability to work independently in a distraction-free remote environment, as a significant portion of the day is spent on the telephone.
- High School Diploma or equivalent; Bachelor's degree or veterinary clinic experience is a plus.
- Prior experience in an administrative, customer service, or data entry role, preferably within the insurance or veterinary industry.
- Demonstrated ability to handle high-volume tasks in a fast-paced environment.
- Active and valid Property & Casualty (P&C) Adjuster License in good standing is preferred; however, a willingness and ability to obtain licensure within a specified timeframe post-hire is required.
Benefits:
- Comprehensive Medical, dental, and vision plan for you and your family
- Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are available
- Highly competitive 401(k) matching
- Generous 20-day PTO Policy, with rollover options. Earn an additional day of PTO each year on your anniversary with Fetch, for a maximum of 30 days
- Paid company (9) holidays, including (1) floating holiday
- Fetch Pet Insurance discount - up to 50% off, up to $1,000 savings/year
- Educational Assistance Program
- Fetch Discount Perks Program
- Volunteering - earn up to 8 hours per calendar year at nonprofit organizations
- NYC Office Amenities: Pet-friendly environment, free lunch, snacks, and additional amenities; transit accessible
- Employee Referral Incentive
- Tuition Assistance
- Commuter Benefits
- Employee Assistance Program (EAP)
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