A claims administrator is responsible for performing administrative duties related to insurance claims. This involves monitoring, processing, and organizing insurance claims, working closely with insurance companies to analyze claims, and determining the extent of company liability. They also review billing, process claims by identifying provider information, and ensure all documentation is accurate for quick payouts[1].
Key tasks include:
- Review and process insurance claims, ensuring accuracy and completeness of documentation[3].
- Investigate and evaluate claims by gathering relevant information and supporting documents[3].
- Communicate with policyholders, agents, and other parties to clarify claim details[3].
- Collaborate with internal teams, such as underwriters and legal professionals, to resolve complex claims[3].
- Maintain and manage files related to claims and compensation, particularly in workers’ compensation cases[1].
- Audit claims for compliance with regulations and company procedures[1].
- Perform preliminary investigations on work-related injury claims[1].
- Adjudicate claims, including making benefits calculations and adjustments as necessary[5].
- Answer phone calls and provide guidance to claimants, ensuring accuracy and completeness in claim submissions[7].
- Data entry, verification of data in databases, and generating necessary reports[7].
Additionally, claims administrators should be detail-oriented, organized, and able to multitask in a fast-paced environment. They serve as the primary liaison between clients and insurance companies and may also make recommendations for new insurance policies or improvements to existing processes[3].