City of McAllen Jobs – Claims Processing Specialist

Job Description:

Under general supervision and procedural control, the Claims Processing Specialist performs specialized claims work related to the processing and mitigation of workers compensation claims, and property and casualty claims; Claims work includes preparation of claims data for time sensitive claims submission into various claim portals, verifying claims information, data gathering and assembling appropriate information, and facts regarding claims workflow; communication with internal / external customers to facilitate progress efforts of all claims; preparation of various reports related to all claims management and maintaining electronic and manual file systems. Employee performs specialized departmental functions and customer services as necessary. Employee may provide limited administrative assistance to the claims coordinator and/or administrative supervisor on some routine duties as assigned.

Job Responsibilities:

• Employee will communicate with internal /external claims adjusters to ensure appropriate claims workflow and mitigation; will occasionally assist network medical providers in providing necessary claims information, and/or appointment compliance.
• Employee will routinely communicate with internal departments in the gathering of data when necessary for claims management.
• Employee performs specialized claims work involving the mitigation and processing of worker’s compensation claims onto various claim portals.
• Employee performs specialized claims work in the review and submission of all property and casualty claims; utilizes a claims portal for management of said claims.
• Employee will assist in the preparation of various claims reports necessary for the review and management of claims for both worker’s compensation and property and casualty.
• Employee will routinely communicate with internal departments to obtain timely work status reports and assist department in the verification of injury on the job leave when necessary.
• Employee plans own work flow and must use some independent judgment in the collection and processing of claims related data.
• Employee is responsible for prompt and accurate submission of all worker’s compensation and property and casualty claims. Most all decisions are guided by existing state regulations and policies.

Job Requirements:

• Must have advanced computer skills and proficiency with
• Microsoft Word, Excel, power point and other Microsoft Office Tools.
• Must be able to deal with internal and external customers in a professional and diplomatic manner.
• Must be bilingual and able to effectively communicate in English and Spanish.
• Job requires an accredited high school diploma or GED equivalent and at least two (2) years (60 credit hours) of advance study or training past the high school equivalency. The City may consider substituting formal education requirement for a total of (5) years five of related work experience.
• Job requires two (2) years of claims work experience.
• Job requires a current, valid Texas Class C driver’s license.
• Must have attention to detail and exceptional organizational skills.

Job Details:

Company: City of McAllen

Vacancy Type: Full Time

Job Location: Harlingen, TX, US

Application Deadline: N/A

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