Claims Assistant

Description

POSITION SUMMARY:

The Claims Assistant will provide administrative support to Claims Adjusters with workers compensation claims and learn the overall process of claims handling.

RESPONSIBILITIES:

• Requires individual to maintain a consistent office presence during normal business hours Monday through Friday. 
• Receive incoming mail and write the applicable claim number on the document. Distribute the mail and/or scan the mail and attach to the claim file as required and direct it to the appropriate claims adjuster or employee. This must be done within 24 hours of receipt of the mail. Medical bills being sent to a bill review vendor just include the claim number or a bill review form from Origami .
• Prepare and mail form letters including acceptance letters, bill denial letters, applicable form letters and wage determination letters for adjuster including required enclosures and appeal forms. All assignments are to be completed within 48 hours of receiving the assignment.
• “Set up” new claims in the software system (Origami) (depending on system authority) based on documentation of a claim from the employer, injured worker, attorney or medical provider. This must be done within 12 business hours of receipt of the claim. The claim is then referred to the claims supervisor to review and complete the assignment to the adjuster.
• Assist the claims adjusters with scheduling timely appointments with medical providers as requested. All assignments are to be completed within 48 hours of receiving the assignment – unless otherwise stated by adjuster.
• Provide copies of claim files and mail the copies to medical providers, attorneys and others as directed by adjuster or supervisor. Copies of litigation related files are to be completed within 48 hours of receiving the assignment. Copies of medical reporting going to providers is to be completed within 5 days but must be sent to the provider in advance of any consultation or evaluation.
• Pay bills for various expenses (depending on system authority), including legal bills, managed care bills and similar expenses as assigned by supervisor or adjuster.
• Scan all (hard copy) correspondence including all paid bills and medical reporting into the claim system both open and closed. Verify that medical bills are indexed and labeled consistent with EOR/EOB related to bill payment. 
• Performs other activities, duties and assignments as needed or requested.
• Must maintain a regular presence in the office. 

Requirements

QUALIFICATIONS:

• Excellent analytical skills and verbal and written communication skills
• Strong organizational skills
• Strong oral and written communication skills
• High school diploma or GED required
• Bachelor’s degree or equivalent experience preferred
• Strong work ethic, timeliness and ability to meet various deadlines
• Must be able to be in office to perform work functions
• No previous insurance experience required.