Claims Clerical Assistant

NFP

Who We Are:

NFP, an Aon company, is a multiple Best Places to Work award winner in Business Insurance. We are an organization of consultative advisors and problem solvers. We help companies and individuals around the globe address their most significant risk, workforce, wealth management and retirement challenges through custom solutions and a people-first approach. To learn more, please visit: https://www.NFP.com.

About ECU

East Coast Underwriters is a leading Managing General Underwriter specializing in Medical Stop Loss coverage for self-funded employer groups. ECU values accuracy, responsiveness, and a commitment to exceptional service within its Claims & Administrative Team.

Position Summary:

The Claims & Clerical Assistant supports the Claims Department in processing Medical Stop Loss Insurance claims and provides essential clerical and administrative assistance to ensure smooth operations. This role is integral to maintaining ECU’s high standards for accuracy, compliance, and customer service.

Key Responsibilities:

• Claims Processing Support:

• • Export claim data into the claims system.
  • Upload documentation, including high-dollar notices and monthly aggregate reports.
  • Log High-Dollar Trigger Notifications for review by senior staff.
  • Communicate with Third Party Administrators (TPAs) to request missing documentation.
  • Assist in the intake, review, and documentation of claims, ensuring all necessary information is collected and entered accurately.
  • Monitor claims for completeness, eligibility, and compliance with plan documents and stop loss policies.
  • Prepare and organize claim files, correspondence, and reports for Claims Auditors and Managers.
  • Support the Claims Team in appeals, audits, and special projects as directed by Claims Management.

• Clerical & Administrative Duties:

• • Maintain accurate records of claims, correspondence, and reports in both physical and electronic formats.
  • Handle phone/email inquiries from clients, providers, and internal teams.
  • Prepare and distribute denial letters, explanations of reimbursement, and other communications as needed.
  • Assist with monthly and year-end reporting, including claims logs and reconciliation tasks.
  • Handle other administrative tasks as requested by management.

• Customer Service:

• • Provide timely updates and support to claimants, brokers, and TPAs regarding claim status and requirements.
  • Ensure compliance with ECU’s policies, state regulations, and data privacy standards.

Qualifications:

• High school diploma or equivalent required.
• Prior experience in insurance claims, medical billing, or clerical support is highly desirable.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook).
• Strong organizational skills, attention to detail, and ability to manage multiple tasks in a fast-paced environment.
• Excellent written and verbal communication skills.
• Ability to work independently and collaboratively within a team.

Preferred Skills:

• Familiarity with Medical Stop Loss Insurance, ICD/CPT coding, and claims adjudication processes.
• Experience working with TPAs, self-funded employer groups, or in a Managing General Underwriter setting.
• Analytical abilities and problem-solving skills.

What We Offer:

We're proud to offer a competitive salary, PTO & paid holidays, 401(k) with match, exclusive discount programs, health & wellness programs, and more. Our PeopleFirst culture focuses on building and nurturing lifelong relationships with our employees because, at the end of the day, we exist to be there for others. The base salary range for this position is $39,000 to $48,000. The base salary offered will be determined by factors including, but not limited to, experience, credentials, education, certifications, skill level required for the position, the scope of the position, and geographic location. Actual base salary offered will be determined on a case-by-case basis. In addition to the base salary, this position may be eligible for performance-based incentives.

NFP and You... Better Together!

NFP is an inclusive Equal Employment Opportunity employer.