Insurance Operations Support Associate bei The RiverStone Group

Job Title  

Insurance Operations Support Associate  

Location 

Hybrid (Manchester, NH )

Summary 

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.

Experience 

• Work experience in a processing environment, in the insurance industry or law firm, preferred.
• 1+ Years of work in a business setting preferred.

• Customer service oriented with the ability for developing long lasting relationships with internal and external business partners.

Required Education 

High School Diploma or equivalent work experience. 

Preferred Education or Certification 

College degree or college level education preferred.  AINS or equivalent designation preferred. 

Supervisory Role  

None 

Travel 

Minimal to none – based on business needs. 

Work Environment / Physical Demands 

This position operates in a professional based collaborative environment and must have the ability to timely produce thorough, accurate work with many competing demands, deadlines, and distractions. The position uses standard equipment such as phones, computers, copiers/printers and filing cabinets. Noise level is moderate.  

Other Duties (Disclaimer Statement):  

RiverStone retains the right to change or assign other duties to this position as needed, or other duties or responsibilities may change or be assigned as needed. 

Core Competencies 

Learning on the Fly: Learns quickly when facing new problems; a relentless and versatile learner; open to change; analyzes both successes and failures for clues to improvement; experiments and will try anything to find solutions; enjoys the challenge of unfamiliar tasks; quickly grasps the essence and the underlying structure of anything. 

Problem Solving: Uses rigorous logic and methods to solve difficult problems with effective solutions; probes all fruitful sources for answers; can see hidden problems; is excellent at honest analysis; looks beyond the obvious and doesn’t stop at the first answers. 

Process Management: Good at figuring out the processes necessary to get things done; knows how to organize people and activities; understands how to separate and combine tasks into efficient flow; knows what to measure and how to measure it; can see opportunities for synergy and integration where others can’t; can simplify complex processes; gets more out of fewer resources. 

Sizing Up People: Is a good judge of talent; after reasonable exposure, can articulate the strengths and limitations of people inside or outside the organization; can accurately project what people are likely to do across a variety of situations. 

Ethics and Values: Adheres to an appropriate (for the setting) and effective set of core values and beliefs during both good and bad times; acts in line with those values; rewards the right values and disapproves of others; practices what he/she preaches. 

Customer Focus: Is dedicated to meeting the expectations and requirements of internal and external customers; Gets first-hand customer information and uses it to improve services; Acts with customers in mind; Establishes and maintains effective relationships with customers and gains their trust and respect. 

Action Oriented: Enjoys working hard; Is action oriented and full of energy for the things he/she sees as challenging; not fearful of acting with minimum planning; Seizes more opportunities than others.  

Informing: Provides the information people need to know to do their jobs and to feel good about being a member of the Team, Unit and/or Organization; Provides individuals information so that they can make accurate decisions; Is timely with information.   

Time Management: Uses his/her time effectively and efficiently; Values time; Concentrates his/her efforts on the more important priorities; Gets more done in less time than others; Can attend to a broader range of activities. 

Self Knowledge: Knows personal strengths, weaknesses, opportunities, and limits; Seeks feedback; Gains insights from mistakes; Is open to criticism; Isn’t Defensive; Is receptive to talking about shortcomings; Looks forward to balanced (+’s and –‘s) performance reviews and career discussions.  

Interpersonal Savvy: Relates well to all kinds of people – up, down and sideways, inside and outside the organization; Builds appropriate rapport, builds constructive and effective relationships; Uses diplomacy and tact; Can defuse even high-tension situations comfortably.  

Written Communication: Can write clearly and succinctly in a variety of communication settings and styles; Can get messages across that have the desired effect. 

Drive For Results: Can be counted on to exceed goals successfully; Is constantly and consistently one of the top performers; Very bottom-line oriented; Steadfastly pushes self and others for results.  

Decision Quality: Makes good decisions (without considering how much time it takes) based upon a mixture of analysis, wisdom, experience, and judgement; Most of his/her solutions and suggestions turn out to be correct and accurate when judged over time; Sought out by others for advice and solutions.