LegalEASE, A Legal Access Company

Administration

• Assisting with the processing of claims accurately and in a timely manner
• Preparation of in-network and out of network claims submitted by attorneys and members
• Generating/sending closed case statements (ccs) forms per request from attorneys
• Following up with attorney network providers or members for additional required information or clarification as needed
• Communicate effectively, professionally and enthusiastically with internal/external clients, colleagues and leadership
• Consistently perform duties assigned with a sense of urgency and accuracy
• Accept personal responsibility for your tasks and actions
• Following through with contacts and other tasks assigned
• Respond to all phone messages and emails within 24 hours/same day
• Complete job requirements in a manner consistent with the core values of LegalEASE

Claims Administrator

Attorney

• Analyze Case Profile
• Contact Member Specialist or Manager for any additional information
• Search for a Provider using the CMS search function and proper procedures
• Confirm Provider is properly credentialed and approved
• Make phone calls to Providers for case matching; all actions and information concerning matching must be documented within the case
• A minimum of five (5) match attempts must be made daily per case
• Confirmation of all matching points must be satisfied: distance, timeliness of referral, benefits, costs, area of practice, and member preferences/needs
• Send proper confirmations to Provider
• Send all proper documents to Provider (i.e. Questionnaire and Contract)
• Notate all applicable information into each case within the CMS
• Properly update the Attorney Database
• Communicate effectively and in a timely fashion with customers, teammates, and management
• Complete a Daily Status Updates when referrals are not ready the same day or the next day, so that the information can be communicated to the member
• Respond to all phone messages and emails within two (2) business hours
• Report daily activity, using the standard Daily Report format
• Assist with status updates, providing referrals, and making follow up calls as needed when call volume or staffing issues require

Claims Administrator

Legal Case Matching Specialist