Claims Research Specialist

About National American Insurance Company
Established in 1987, National American Insurance Company (NAICO) has built a solid reputation as a regional insurance carrier. Headquartered in Oklahoma, NAICO serves the Southwest, Midwest and Mountain States. We pride ourselves on maintaining underwriting discipline with an emphasis on growing our company surplus through underwriting returns. NAICO's mission is to "Set the standard that others strive for..." in all aspects of our business.

National American Insurance Company (NAICO) is an Oklahoma-based regional insurance carrier established in 1987. Licensed nationwide, we partner with agents to offer diverse commercial property and casualty coverage. With an "A" Excellent financial strength rating from A.M. Best, NAICO is committed to providing reliable, high-quality insurance services. We are currently seeking a highly motivated and detail-oriented Claims Research Specialist to join our team.

Position Overview:

A Claims Research Specialist researches insurance claims and assists with investigations by coordinating documentation such as police reports, medical records, and social media records to determine coverage eligibility. They may also assist with state and federal reporting and ensure regulatory compliance.

Essential Duties and Responsibilities:

• Claim Investigation: Order reports; review and validate.
• Documentation Review: Use AI to analyze police reports, SI and PI, and medical/hospital records.
• Communication: Act as the primary contact for claim research and Medicare reporting activities. Process and report Medicare claims.
• Compliance & Audit: Act as the secondary contact for regulatory reporting .
• Legal Bill Processing and Auditing: Serve as the point of contact for all legal billing issues, including correcting errors and ensuring proper allocation.
• Communication Template and Report Creation and Management: Edit and create templates for all claims department forms and activities. Create and run reports in the AS400 and Guidewire systems.
  

Qualifications:

• Analytical Skills: Strong ability to evaluate complex documentation, such as medical records and investigation reports.
• Technical Proficiency: Knowledge of billing processes, research and report review, analysis and reports.
• Communication: Excellent written and verbal communication.
• Detail-Oriented: Ability to maintain high accuracy in data entry and review.
• Education/Experience: Bachelor's degree with 2 to 4 years of experience in electronic research and analysis, preferably within the insurance industry.

Note:

Onsite training provided in Chandler, OK, with the possibility to transition to a hybrid/remote schedule after training is completed.

Why NAICO?

• Competitive salary and benefits package
• Opportunities for professional growth and development
• Collaborative and supportive work environment