Claim Assistant

Job Description:

SUMMARY:   The primary focus of this position is to provide support to the Claim Team. This includes but is not limited to returning phone calls, creating notes in system, closing claim files, and assisting in preparation of file reviews as well as other miscellaneous support activities. Computes medical bills associated with accidents and ensures timely payment.

RESPONSIBILITIES/TASKS: 

• Supports the customer service work and processes for the multi-functional claims team.
• Answers general claim inquiries from providers and provide verification of claim status.
• Communicates and collaborates with team members to ensure the appropriate and timely handling of claims.  Supports the team as required.
• Supports the account management process appropriately for the team's book of business.
• Computes the proper payment for the medical bills for non-indemnity and simple indemnity claims directly associated with the accident or activity.  Computation is based on knowledge of the treatment given the individual and its relationship to the injury to relieve and/or cure the injury sustained as well as workers’ compensation provisions in the state the employer is domiciled. 
• Provides administrative support to the Claims Department using word processing and spreadsheet applications. (Lien letters, timelines for medical treatment/events, etc.)
• Ensures that all payments are made in an accurate and timely manner and that all files are closed to meet internal performance standards while complying with state legislation to avoid penalties and reduce the amount of supplemental bills.
• Adheres to the Employee Code of Ethical Conduct.
• Completes other duties and special projects as requested

This position description identifies the responsibilities and tasks typically associated with the performance of the position.  Other relevant essential functions may be required.

EMPLOYMENT QUALIFICATIONS:

EDUCATION OR EQUIVALENT EXPERIENCE:

High school diploma or G.E.D required. College coursework in English, Mathematics, Business Administration or Administrative Management OR the equivalent in insurance-related course work and experience is required. At least 2 years of administrative experience. Continuous learning required, as defined by the Company’s learning philosophy. Certification, or progress toward, highly preferred and encouraged.

EXPERIENCE:

Previous experience in an insurance environment or previous knowledge of workers' compensation laws is desired. Knowledge of medical terminology is preferred.

SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: 

• Ability to work independently as well as in a multifunctional business unit is essential.
• Effective oral and written communication skills are essential.
• Excellent customer service and organizational skills are essential.
• Ability to manage multiple priorities and adapt to changing workflow in order to still meet deadlines and goals are essential.
• Proficient in Microsoft Windows
• Attention to detail and analytical skills required.
• Ability to enter and verify alpha/numeric data accurately.

WORKING CONDITIONS:

Work is performed in an office setting with no unusual hazards. 

The qualifications listed above are intended to represent the minimal skills and experience levels associated with performing the duties and responsibilities contained in this position description. The qualifications should not be viewed as absolute standards, but as general guidelines that should be considered with other position-related criteria.

Pay Range - Actual compensation decision relies on the consideration of internal equity, candidate’s skills and professional experience, geographic location, market, and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $38,100 and $64,000.

We are an Equal Opportunity Employer.  Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an "at will" basis.  Nothing herein is intended to create a contract.

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