Claims Assistant

General Description
The Claims Assistant provides administrative support to their assigned business unit.

Essential Functions

• Organizes the digital claim records for uniformity by removing duplicate records and top-lining documents.
• Completes 10-day and 6-month claim maintenance checklists to ensure the highest level of claims statistical data processing in accordance with multiple calls for data. Processes corrections to data error crits as required.
• Completes manual Medicare query of claims at the CMS COB&R site as needed and documents the digital claim record.
• Processes class code corrections that accurately depict the scope of an injured workers job and payroll.
• Completes claim documents in both ImageRight and Powersuite.
• Completes closure re-opens and reassignments of all claim files as submitted by Supervisory personnel.
• Assists with record subpoenas and completes lien reviews organized with a worksheet summary.
• Completes vendor referrals by service specialty and utilization review submissions to Rising.
• Maintains contact with the WCAB for status updates on claims where named as a party to suit in error.
• Complies with Maximus responses following IMR for timely fulfillment.
• Reviews adjuster ImageRight tasks daily for medical authorization requests.
• Provides administrative assistance to claim adjusting team members as needed.
• The Claims Assistant II provides back-up in the entry of manual payments to the Claims Payable Analyst.
• Other duties and projects as assigned.

Competencies/Qualifications

• Professional telephone demeanor good verbal and written communication skills good listening skills along with strong organizational skills.
• Thorough knowledge of workers compensation claims procedures and policies.
• Possess a strong understanding of human nature and motivation principles.
• Readily control/handle problem issues in times of stress and in a climate of conflict and/or adversity.
• Computer literacy including strong familiarity with Microsoft Office Suite. Ability to type 45 WPM.
• Basic understanding of business technology.
• Responsiveness to changing business needs.
• Ability to work well under pressure and multi-task in a fast paced environment while continually paying attention to detail.
• Ability to adhere to the code of ethical conduct.
• Ability to take direction and make decisions.
• Ability to learn new procedures quickly and adapt to a changing environment.
• Ability to work in a team environment.
• Ability to work with limited supervision.

Education/Experience Requirements

• Minimum Education: High School Diploma or equivalent.
• Preferred Education: College degree preferred.
• 1-2 years of relevant claims processing experience preferable in the workers compensation field or similar experience.
• Desire for career development within the insurance industry.

Work Environment
This job operates in a clerical office setting. This role routinely uses standard office equipment such as computers telephones photocopiers fax machines and the like.

Physical Requirements

• Candidate should be able to hear clients and talk with clients over the telephone.
• Sitting for 4 hours of time is usual in this role.
• Candidate should be able to lift 10-15 pounds.
• Large amounts of keyboarding and working with a computer mouse requires dexterity of the hands.
• Candidate should be able to use their hands and arms to reach for standard items.
• Candidate must be able to use close distance and color vision.

Acrisure is committed to employing a diverse workforce. All applicants will be considered foremploymentwithout attention to race color religion age sex sexual orientation gender identity national origin veteran or disability status. California residents can learn more about our privacy practices for applicants by visiting the Acrisure California Applicant Privacy Policy available at Executive Search Firms & Staffing Agencies: Acrisure does not accept unsolicited resumes from any agencies that have not signed a mutual service agreement. All unsolicited resumes will be considered Acrisures property and Acrisure will not be obligated to pay a referral fee. This includes resumes submitted directly to Hiring Managers without contacting Acrisures Human Resources Talent Department.