Claims Concierge

**Claims Concierge**

at Clements Worldwide Washington, DC At Clements Worldwide, we enable people and organizations to have the freedom to live and operate anywhere in the world by providing them with a broad array of specialized international insurance solutions. We are committed to a culture of excellence where we empower you to further develop your skills and evolve your career.

We are seeking a **Claims Concierge** to act on behalf of our clients who purchase international employee benefit policies including; Group Health, Individual Health, Personal Accident, Life, Disability and Workers Compensation, in resolving claims service issues.

**Before we go any further, we do have some deal-breakers. You must have:**

* 2+ years experience in at least one of the roles listed below

+ Claims Account Manager

+ Claim Denials & Appeals

+ Claims Concierge

+ Claims Examiner

+ Claims Processing & Dispute Resolution

+ Loss Adjuster for Medical Claims

+ Medical Claims Adjuster

+ Medical Claims Concierge

+ Sr. Claims Examiner

+ Other Similar Role

* accident & health license or be willing to obtain within 90 days of hire

* knowledge of commonly-used concepts, practices, and procedures within the claims/health insurance field (this is essential)

* familiarity with insurance products and insurance terminology

* the ability to work on-call on occasion

* exceptional written and verbal communication skills in fluent English

* ability to effectively address and correct customer complaints and concerns, projecting a calm, affable demeanor and professional phone manners

* strong facilitation, conflict resolution and investigative skills

* legal authorization to work in the United States

***We are glad you are still reading.***

A little bit about some of the day-to-day in this role this will involve effective communications with clients, group contract administrators, carrier claims examiners, insurance company executives, and all levels of TPA personnel. This position is to obtain the best possible customer service resolution to each issue, and may involve working with claims personnel to clarify claims falling into "grey areas", rectifying adjudication mistakes and/or providing understandable explanations, and handling questions regarding other claims (i.e. property casualty) in a similar fashion from time to time.

***A little bit about how to succeed in this role:***

* effectively resolve claims issues or problems (that have arisen beyond normal processing) in an accurate, effective, and timely manner via letter, email, an/orphone calls

* adeptly explain complicated or unusual situations to carrier and TPA personnel.

* have the ability to explain health insurance policy clauses in easily understood laymans terms, assisting members with claims and benefit queries, and helping them with denied or pended claims

* resolve issues (if any) by proactively identifying claims issues by communicating with doctor / providers, HTH liaison, providing timely updates on claims statuses

* provide weekly review of claims reports denied, pending, high dollar denied claims, high out-of-pocket / out-of-network reports, and appropriately document all customer contacts, maintaining and updating files in the system

* possess a strong capability with Microsoft Office Suite, specifically Excel

* interpersonal skills to interact with people at all levels of responsibility

***It will be great if you also happen to have these qualifications:***

* international medical insurance claims experience

* bachelors degree or higher education

***As we all know, compensation isnt just the salary. Here are some of the benefits of working at Clements:***

* Comprehensive health, dental, vision, and prescription care

* Generous paid time off with unlimited rollover. Plus, you get an extra day off for your birthday!

* 3 mental health days

* 10 paid holidays

* 401K: 100% matching up to 5% with immediate vesting

* 100% paid parental leave

* "Dress for Your Day" dress code

* Education assistance: licenses, certifications, and continuing education

* Life insurance: 1.5 times your annual salary

* Short-term and long-term disability insurance

* Flexible Spending Accounts

If youre still reading and are interested in helping to take Clements into 2022 and beyond, lets have a conversation here at our Clements corporate office in DC (masks, distancing), or we can meet virtually. The choice is yours! Well discuss the day-to-day highs and lows of this role and answer any of your questions in your first interview.

...@clements.com.

At Clements, we celebrate and thrive on differences for the benefit of our team members and clients. Clements is an equal opportunity employer. Employment here is based solely on a person's merit and qualifications directly related to professional competence. Clements does not discriminate against any employee or applicant because of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), or any other basis protected by law.