Claims Analyst jobs in Summerville, SC

ESSENTIAL JOB FUNCTIONS

•  Manages day-to-day claims operations, including claims evaluation, adjudication, and customer service in accordance with agreed quality and production standards. 
  •    Processes claims in a timely manner and complies with industry fair claims practices and applicable state regulations concerning the processing of claims.
  •    Coordinates and facilitates the management of workers compensation claims for Dorchester County), including assessing, investigating, reviewing, negotiating, and determining workers compensation claims, weekly and provisional liability entitlements, coordinating medical treatment and indemnity payments in accordance with SC’s laws and regulations.
  •    Manages, and processes insurance claims and information for external insurance companies, including worker’s compensation, tort, property, liability, crime, and cyber insurance.
  •    Maintains insurance on all County owned property, buildings, building contents, fleet vehicles; and evaluates appraisals of property for coverage level endorsements; prepares necessary insurance budget requirements and cost allocations. 
  •    Provides settlement recommendations for review and approval by the Director RMS; resolves moderately complex issues regarding claims operations; and maintains all claims related documentation. 
  •    Assists in the development, implementation, evaluation, review, and improvement of the County’s claims management/administration policies, procedures, and processes.
  •    Serves as liaison among the Dorchester County, insurance carriers, third party administrators, nurse case managers and attorneys; obtains and furnishes information to answer questions from carriers and coordinates meetings; attend various meetings, mediations, hearings and informal conferences regarding related issues; processes, generates and verifies all workers compensation forms including First Report of Injury (WCC Form 12 A) and Statement of Earnings (Form 20); handles payments for claims, and assist with Workers’ Compensation audit procedures and completion.
  •    Manages department’s purchasing-related activities including but not limited to, processing requisitions, purchase orders, invoices.  
  •    Attends trainings, meetings, seminars and/or workshops to enhance job knowledge and skills.
  •    Attends staff, committee, and county meetings as required.
  •    Assists the Director in complying with and analyzing property and casualty claims and loss information to identify trends, risk exposures and hazards; assists in the preparation and distribution of loss reports and recommendations to County officials, department heads and supervisors to reduce liability; implement loss prevention programs and assist in the analysis of the causation of specific department losses.
  •    Handles claim files (uploads documents, files paperwork, locates/requests missing/revised documents and distributes information as needed).
  •    Coordinates with claims adjusters and TPAs for automobile and general liability claims. Follow-up on repair estimates needed for insurance claims.
  •    Processes claims file correspondence to the appropriate claim files. Proficient in relabeling documents; working within department’s network folders. 
  •    Processes insurance premiums and renewals; allocates funds from the correct departments; and handles additions/deletions of County assets to insurance policies. Manages the accounting associated with insurance credits. Assists in the annual renewal process for properly insuring County assets.
  •    Maintains documentation for federal programs such as Occupational Safety and Health Administration (OSHA); maintains OSHA 300 logs and statistics; and prepares annual reports.
  •    May prepare and/or process quarterly random drug testing reports per Dorchester County’s Drug and Alcohol Policy.
  •    Prepares complex and confidential correspondence, memoranda, reports, etc. 
  •    May assist the department in the preparation of training classes; prepare fliers, handouts, or other materials to conduct and promote training classes; and maintain records on training program attendance. 
  •    May assist in departmental budgeting and financials, reconciliation of accounts and monitoring of grants.
  •    Operates a personal computer and appropriate software packages or its equivalent pertaining to departmental activities.
  •    Receives, reviews, prepares, and enters data into various applications, databases, and/or Excel spreadsheets. Logs in claims updates in claims database, created and maintains claims files, and generates claims reports.
  •    Prepares monthly and ad-hoc reports as required.
  •    Carries out special projects, serves on various committees a needed, and performs assignments as directed by Department Head or designee.
  •    Serves as department’s timekeeper.
  •    May share on-call duties with other staff members.
  •    Performs other related job duties as assigned. 
  •    Develops data analysis reports for the department; performs analysis on weekly and monthly basis; makes policy and operational recommendations to Department Head based on statistical analysis. Assists in preparing complex reports and metrics. 
  •    Provide input and assistance in identifying, establishing, and maintaining internal operating procedures.
  
  

Education and Experience:

High school diploma or GED supplemented by education or experience in a closely related field.

Requires at least five (5) years of related work experience. 

Special Qualifications:

Intermediate computer skills to include Word, Excel, PowerPoint, Outlook and other productive platforms.
Must have and maintain a valid South Carolina driver’s license with a safe driving record.
Excellent customer service, verbal and written communication skills.