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SR Support Specialist - SIU

Apply Location Miami, Florida Requisition Number R-88990

Job Purpose:

The SIU Senior Support Specialist’s primary responsibility is to assist SIU investigators and claim adjusters with the investigation and analysis of claims. This role will have primary focus to support major cases, complex claims, and medical provider reviews.

Responsibilities:

  • Investigation Support
    • Conducts background and social media checks to support on-going investigations
    • Provides investigative support to SIU Investigators as needed
    • Acts as liaison with other carriers for immunity requests
    • Prepares documentation with the applicable Immunity and/or Arson statute to request information from other carriers
    • Prepares claim files to provide to the National Insurance Crime Bureau or Department of Insurance
  • Medical Provider Review
    • Conducts Medical Provider and Clinic reviews/backgrounds
    • Reviews provider licenses via AHCA and other state specific governing bodies
    • Provides summary of medical records review
  • Data Analytics & Project Management Support
    • Assist with various SIU Projects which requires a review of claim files and analysis in preparation for data analytics
    • Serves as backup for SIU Analysts for fraud/subro AI triage
    • Provides data entry on SIU/Subrogation claim files as needed
    • Supports vendor vetting program and maintains approved vendor database

Qualifications:

  • High School Diploma or equivalent
  • Two years insurance experience
  • Five years of experience with MS Office products
  • Five years Customer Service experience
  • Proficient in knowledge of insurance claims handling processes
  • Basic understanding of insurance medical claim guidelines
  • Basic understanding of CPT & ICD9 Codes
  • Excellent communication skills

Preferred Skills:

  • Strong organizational and prioritization skills
  • Ability to work both independently and in a team environment
  • Ability to multi-task and prioritize
  • Ability to manage sensitive information and confidential information
  • Bilingual (Spanish)
  • One-year experience in the healthcare field

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Ignacio D. - Senior Operations Analyst

Whether I'm working with people in Argentina or Chile or Miami, we all feel like we're part of the same company. And within my own group, we share ideas and analyze as a team - and drive for change, for improvements. We'll show each other how we do things and lend advice.

I also enjoy the focus on work-life balance - in the workplace, we're offered exercise classes or stretching classes with a trainer, for example. I've had the flexibility to take classes and training. And, we have the opportunity to give back to the community through events held throughout the year.