Claims Assistant 1

ESSENTIAL RESPONSIBILITIES

• Reviews and prioritizes daily diary instructions from Claims Professional and/or Supervisor, ensuring appropriate urgency is given to time sensitive tasks (e.g., payments, regulatory notices), and promptly notifying of any impediment to task completion. Communicates with Claims Professional and/or Supervisor to clarify and rectify discrepancies and/or obtain proper approval prior to completion.
• Accurately assesses benefit eligibility pursuant to State regulatory guidelines. Issues correlating payments and benefit notices timely, including amended notices when applicable. Issues compensability notices timely adhering to State regulatory guidelines and company protocols.
• Generates new claim set up notifications/correspondence for incoming claims and for those claims identified for transfer from the Medical Claims Specialist Unit to Indemnity Unit. Secures wage information needed timely upon identification of need for transfer.
• Assists with scheduling medical evaluations as needed. Routinely updates on disability status post-appointment.
• Appropriately schedules and manages use of vendors when necessary for transportation, translation, and subpoena services.
• Coordinates service of required documentation to appropriate parties on litigated claims: Prepares index of documentation. Assists with cover letter as necessary. Ensures appropriate documentation is included in package and any necessary redaction is completed. Verifies service completion.
• Timely submits necessary internal service requests with required documentation to appropriate department for handling: Check pull/voids, stale-dated, and stop payment requests. Reissuance of medical payment (Medical Bill Review). Non-Medical Bill Review payment requests (legal billing and non-medical vendor requests). Return-To-Work referrals. W-9 coordination for payment requests.
• Timely and concisely notes updates upon completion of tasks within the Claims Tracking System. Appropriately escalates issues/red flags to Claims Professional and/or Supervisor.
• Completes other ancillary services as needed, including coverage of Reception desk.

QUALIFICATION

• EDUCATION: High School Diploma or HS Equivalency credential required.
• TECHNICAL SKILLS: Ability to read and interpret documents such as medical reports, legal documentation (settlement documentation), and State regulatory guidelines governing workers compensation. Ability to write routine correspondence. Knowledge of Microsoft Office 365 applications (e.g., Word, Excel) and be proficient on applicable databases, systems, and vendor software programs. Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

NEEDED COMPETENCIES

• Time Management/Sense of Urgency
• Attention to detail
• Service oriented
• Able to manage multiple priorities effectively
• Sound communicator
• Excels in the spirit of collaboration

WHAT WE OFFER

• Modern Office Setting
• Free On-Site Fitness Facility
• Free On-Site Garage Parking
• Paid Time Off
• Paid Holidays
• Immediate Vesting of Retirement Savings + Company Match
• Group Health Insurance (Medical, Dental, and Vision)
• Life and AD&D Insurance
• Long Term Disability Insurance
• Hospital Indemnity Insurance
• Accident and Critical Illness Insurance
• Flexible Savings Accounts
• Paid Community Volunteer Day
• Employee Assistance Program
• Tuition Reimbursement Program
• Employee Referral Program
• Diversity, Equity and Inclusion Program