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Adjuster - Claims Management
Adjuster - Claims ManagementAmerican Water Resources LLC • Naperville, IL, US
Adjuster - Claims Management

Adjuster - Claims Management

American Water Resources LLC • Naperville, IL, US
2 days ago
Job type
  • Full-time
Job description

Job Description

Job Description

Who We Are

Oncourse Home Solutions (OHS) is a people-centric, $500M organization that is owned by private equity firm, Apax Partners operating under the brands American Water Resources, Pivotal Home Solutions and American Home Solutions. We do what is right for our people so they can do their best when serving our 1.8+ million customers across the U.S. Our mission is to create lasting value for our customers and our partners by helping homeowners navigate the unexpected, reduce costs, and make homeownership enjoyable for all. Our vision is to make our products and services accessible to our customers and our partners by becoming the most trusted and reliable home solutions organization in the market. We are committed to fostering an environment that embraces diversity in all forms, where our employees, customers and partners feel valued, respected, and supported.

As a US-based warranty provider, we provide expertise in safety and homecare to our customers. Our integrated solutions meet customer needs both inside and outside the home. Inside the home we protect critical aspects of home function such as plumbing, heating and cooling, appliances, power surges, hot water heater, and interior electrical. Outside the home we provide protection for critical lines (water, gas, wells, sewers, electric and septic). We primarily go to market B2B2C, partnering mostly with water / gas / electric utilities and municipalities to offer our product leveraging their brand for marketing and often adding our subscription fee to the water / gas / electric bill itself. When our customers need help with home maintenance, repair, or coverage, OHS is there. This is what it means to be an ‘Oncourse SUPER’—Successful, United, Progressive, Empathetic, Reliable. SUPERs get it done. We sweat homeownership so our customers and partners don’t have to.

As an equal opportunity employer, our employment decisions are based on business needs, job requirements and individual qualifications without regard to race, color, religion, age, sex (including pregnancy), sexual orientation, gender identity, national origin, ancestry, marital status, parental status, mental or physical disability, military or veteran status, or any other basis protected by federal, state, or local law. Oncourse Home Solutions is committed to recruiting and retaining talented applicants and to providing all employees with a workplace free from discrimination and / or harassment.

Position Summary

The Adjuster - Claims Management is responsible for the review, investigation, evaluation determining eligibility of claims created, and negotiating as necessary the resolution of claims that are in compliance with all policies and any state regulatory requirements. This role manages a large claim volume keeping adjudication at a high standard including but not limited to ensuring timely and accurate payments to service provider network and customers, and proactively improve process efficiencies by assisting with system enhancements of the claims management system that also support growth. This position is responsible for ensuring all Cost of Goods (COGS) are processed accurately and timely for financial accounting and leadership for month end.  Located at our office in Naperville, our office environment is a key driver of our company culture and employee experience, so a regular in-office hybrid model (T-TH in office and M & F remote) is required.

Responsibilities include but are not limited to :

  • Ensure customers and providers are paid timely and accurately within the terms and conditions of programs following best practices with ensuring compliance with state regulatory requirements.
  • Ability to communicate effectively with internal and external customers and keep challenging situations from escalating including customer transactions related to ineligibility.
  • Responsible for handling incoming customer reimbursements requests from start to finish.
  • Validate daily NHS wire payment and exceptions.
  • Manage the reconciliation of Customer Preferred Pricing transactions.
  • Subject matter expert for all claims questions and inquiries with ability to train employees on claims processes and policies
  • Analyze and validate a high level of claims data and entry into propriety operating system daily including daily audit and reconciliation of data and files.
  • Proactively address providers and team on provider non-adherence to contract coverage and terms.
  • Develop and build effective relationships within the department as well as with other departments including the contractors in our service provider network.
  • Oversee the review and approval process for invoices and reimbursements to maintain financial accuracy and accountability.

Claim Management Oversight :

  • Understand database applications and operating systems to update SOP and job aids as appropriate for the department. Provides process improvement recommendations.
  • Subject matter expert on all claims processes to provide perspective to support business initiatives as well as system enhancements for Claims Management systems helping with writing requirements, and testing to ensure optimal solutions by collaborating with core teams limiting risk to the business.
  • Understand the impact of other departments on claims management and how to identify, resolve situation identifying trends, discrepancies for areas of solutioning to rectify situations
  • Assist claims management department with daily workload and month end processes
  • Facilitate onboarding and provide training for new employees to ensure successful integration and alignment with organizational standards and expectations.
  • Oversee the resolution of complex or escalated claim matters and serve as point of contact for initial claims inquiry emails.

    • Personal Accountabilities :

  • Responsible for collaborating with teams to drive operational excellence to accomplish department and business objectives.
  • Complete performance goals in alignment with Company goals and objectives.
  • Receptive to performance feedback and continuously seeks to improve own
  • Effectively maintain department workflow and personal productivity while performing job duties timely and accurately

    • We're Excited if this is You!

    Experience and Qualifications of the Role

  • Minimum of 1-3 years of proven employee management with focus on customer service, invoice processing or similar field.
  • 1-3 years' experience in Accounting, A / P, Billing, A / R, or Claims.
  • Strong decision making and analytical skills with the ability to enter at least 40 WPM.
  • Detail orientated with strong organizational skills and the ability to adapt to changing priorities.
  • Strong and effective verbal and written communication skills with the ability to influence others.
  • Self-starter, creative problem solver, persuasive and thorough, and strong team player.
  • Ability to deescalate customer or provider challenging situations without management.
  • Ability to work with minimal supervision.

    • Computer Skills Needed to Perform the Job

  • Proficiency in Microsoft 365

    • Education

    Bachelor’s degree in marketing, finance, business (or relevant experience)

    We offer a compelling total rewards package that includes a competitive base salary and comprehensive benefits to support your total well being.  The base pay range for this position is $25 to $35 per hour. The specific pay offered will depend on qualifications, experience, education and skill set. The compensation offered may also include an annual performance-based bonus, sales incentive plan or commission target.

    Our benefits include, but are not limited to, healthcare, life insurance, paid time off, retirement, commuter benefits, and education reimbursement. Exact compensation may vary based on skills, experience, and location.

    Join our SUPER Team and Enjoy Amazing Benefits!

  • Competitive Compensation : We value your hard work and are proud of our competitive pay for performance philosophy.
  • Comprehensive Health Coverage : Medical, dental, and vision insurance options, plus paid short-term and long-term disability coverage.
  • 401(k) Plan with 4% Company Match : Secure your future with our robust retirement plan.
  • Generous Paid Time Off : Take the time you need to recharge and relax.
  • Education Assistance Program : Invest in your growth and development with our support.
  • FSA / HSA Options : Flexible spending and health savings accounts to manage your transportation and dependent care expenses.
  • Employee Wellness : Access to EAP, health, legal, and financial resources to support your overall well-being.
  • Vibrant Company Culture : Monthly Townhalls, employee recognition programs, and Employee Business Resource Groups (EBRGs) to keep you engaged and connected.

    • Competencies

    Customer Focus - Identifying : understanding and meeting customer expectations both internally and externally.

    Drive for Results - Can be counted on to exceed goals successfully; is constantly and consistently one of the top performers; very bottom-line oriented; steadfastly pushes self and others for results.

    Ethics and Values - Effective set of core values and beliefs during both good and bad times; acts in line with those values; rewards the right values and disapproves of others; practices what he / she preaches.

    Integrity and Trust - Can present the unvarnished truth in an appropriate and helpful mner; keeps confidence; admits mistakes; doesn’t misrepresent him / herself for personal gain.

    Managing Diversity - Embracing and valuing differences in everyone. This includes the commitment to work constructively and collaboratively with all people in all aspects of our business.

    Timely Decision Making - Making Makes decisions in a timely manner, sometimes with incomplete information and under tight deadlines and pressure; able to make a quick decision.

    Functional or Technical Skills - Has the functional and technical knowledge and skills to do the job at a high level of accomplishment.

    Marketing / Customer Focus - Identifying : understanding and meeting customer expectations both internally and externally

    No external recruiter or agency calls / communication will be accepted. Qualified candidates should apply online.

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    Claim Adjuster • Naperville, IL, US