Claims Assistant

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.
• Generate new claim set-up notifications/correspondence for incoming claims and for those claims identified for transfer from the Medical Claims Specialist Unit to an Indemnity Unit. Secures wage information needed timely upon identification of need for transfer.
• Assists with scheduling medical evaluations as needed (e.g., Primary Treating Physician, Ancillary Services such Physical/Occupational Therapy, or State Qualified Medical Evaluations) and routinely obtains 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 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.

QUALIFICATIONS

• Education: Minimum of High School Diploma or HS equivalency credential (e.g., GED, HiSET) required.
• Experience: Minimum of 1 year of related administrative experience preferred.
• Written Communication: 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.
• Verbal Communication/Collaboration: Strong communicator with good interpersonal skills. Ability to successfully build relationships and adapt communication style in various environments/with audiences of all levels. Listens and requests clarification. Responds well to questions and feedback. Speaks clearly and persuasively in a manner suitable to the understanding of the listener.
• Computer Skills: Knowledge of Microsoft Word and Excel with ability to become proficient on applicable databases, systems, and vendor software programs.
• Time Management/Sense of Urgency: Effectively manages time in order to accomplish work. Appropriately prioritizes tasks according to importance and time constraints. Regularly keeps others informed of task status. Uses tools (e.g., Outlook calendar) to stay organized.
• Attention to Detail: Works in conscientious, consistent, and thorough manner. Produces accurate work and delivers within specified timelines. Thoroughly reviews work prior to submission.
• Customer Service: Dedicated to meeting the needs of others in the organization. Responds timely to requests for service and assistance. Solicits feedback to improve service and enhance existing procedures.
• Math Ability: 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.

WHAT WE OFFER

• Work-Life Balance
• Work From Home Program (up to 2 days per week upon eligibility)
• Modern Office Setting
• Free On-Site Fitness Facility
• Free downtown shuttle route
• Two-minute walk from Walnut Creek BART Station
• Three-minute car ride from CA-24 and I-680
• Free On-Site Garage Parking

BENEFITS

• Paid Time Off
• Paid Holidays
• Retirements Savings Match
• Group Health Insurance (Medical, Dental, and Vision)
• Life and AD&D Insurance
• Long Term Disability 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