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Claims Assistant
4 months ago
Overview:
Responsible for assisting Examiners in every aspect of claims administration. The Claims Assistant will identify, prevent and mitigate potential penalties as well as deliver 3 point contact.
Keenan, an Accretive company, is an insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. Keenan specializes in providing consulting services in the areas of: employee benefits, workers' compensation, loss control, financial, and property & liability.
What You'll Do:
- Input data entry on all new claims.
- Provide indemnity payments and cycles.
- Request wage statements and wage statement calculations.
- Identify, prevent and mitigate potential penalties.
- Deliver 3-point contact (MO &/or Indemnity files) to verify the mechanics of the injury, compensability and discharge.
- Review all DWC letters (initial notices).
- Input form letters (30 day closing letters when appropriate).
- Calculate and pay mileage and benefits.
- Verify lost time and waiting periods.
- Review and manage modified duty.
- Perform maintenance of current diary.
- Input basic notes relating to claim, status and treatment.
- Identify issues requiring conversion to Indemnity to include supporting documentation.
- Refer all x-rays and diagnostic services to PRIME for utilization review.
- Process medical bills daily to avoid penalty and interest.
- Investigate all questionable claim circumstances and refer to the examiner when needed.
- Maintain 100% closing ratio.
- Return phone calls within 24 hours.
- Review mail/bills daily - paperless system.
- Correct error report daily.
- Maintain client/claimant satisfaction.
- Perform indemnity payments and cycles.
- Request wage statement and wage statement calculations.
- Input all DWC (Division of workers’ compensation) letters (notice, including denials).
- Process QME (Qualified medical evaluator) to receipt of report.
- Type Stipulations, mail to employee and WCAB (Worker’s compensation appeals board).
- Type Compromise & Release and mail to the employee and WCAB.
- Schedule appropriate medical appointments, calculate mileage, and send appointment letters.
- File and serve appropriate documents.
- Complete investigation and copy service request forms.
- Refer all PRIME deletions to office designee only.
- Complete IMR (Independent Medical Review) and process in a timely and accurate manner.
- Interact with nurse on case management regarding return to work status.
- Maintain and update Work Status tab.
- Input statute letters, delay letters, or any other required initial letter.
- Interaction with nurse on case management regarding return to work status.
- Other duties as assigned.
What You'll Need:
- Minimum of one (1) year of Claims Assistant experience required.
- Ability to multitask, communicate effectively in writing and verbally, within all aspects of job requirements.
- Experience in insurance and/or Workers Compensation claims is preferred.
- Proficient in Microsoft Outlook, Excel, PowerPoint and Word. Adept at accessing business data from the Internet when required.
What's in it For You?:
To help you make the best decision for your personal growth, it’s important to us to share a glimpse of what we offer our top asset, our people:
- Competitive base salary.
- Generous 30+ Days Comprehensive Paid Time Off Package inclusive of Paid Time Off, 10 Company Holidays, 2 Floating Holidays, 5 Sick Days, and 2 Volunteer Days.
- Health benefit options with you in mind; 5 affordable medical plan options with rates based on your salary, company paid HSA contribution with eligible HSA plan selection, 2 dental plan options offering orthodontia coverage and 3 cleanings per year, and 2 vision plan options.
- Company match 401(k) plan - 50% up to 6%
- Support of your fitness wellness goals We offer up to 75% off at over 11,000 gyms and fitness centers.
- Opportunity to prioritize your mental health with 24/7 access to licensed therapists.
- Pet benefits & discounts.
- Access to our Employee-led Resource Groups (ERGs) that lend a voice to the variety of demographics represented throughout our company.
**Compensation**:
The target salary range for this position is $38,000.00 to $50,000.00 (US Dollar) annually. The actual salary will vary based on applicant’s education, experience, skills, and abilities, as well as internal equity and alignment with market data. The salary may also be adjusted based on applicant’s geographic location. Remote work environment flexibility.
Grow, with us:
**Accretive** is a collection of elite specialty and wholesale agencies supported by experienced industry leaders. Our expertise is broad, and our innovative culture runs deep. We value relationships above all else and consistently deliver best in class customized solutions and service you can trust.
**Accretive **is passionate about fueling our clients’ innovation and growth. That makes us the perfect place for creative, dyn
