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Workers Compensation Claims Assistant I

1 month ago

Fresno, United States Intercare Holdings Insurance Services, Inc. Full time

Job Type

Full-time

Description

Summary:

Reports directly to the unit Claims Supervisor but takes primary direction for the assigned Claims Specialist(s). Responsible for providing clerical operations support to assigned Claims Specialist(s).

Essential Duties and Responsibilities:

  • Prepares new claims files
  • Calculates TTD, Wage Loss, VRMA and PD benefits
  • Issues compensation payments on diary schedule
  • Issues Benefit Notices
  • Doctor status calls and Employee/Employer contact calls
  • Employer contact calls to confirm light duty/modifies work
  • Works closely with Claims Specialist to complete clerical assignments
  • Prepares litigation documents such as C&R, Stipulations, Answers, etc
  • Prepares rehabilitation forms for filing with the rehabilitation unit
  • Handle calls from providers inquiring about unpaid bills and bill related questions
  • Review Mail and process direct pays bills such as Mileage Reimbursement
  • File and Serve duties (as needed)
  • Notepad documentation in Portal
Requirements

Competency:

To perform the job successfully, an individual should demonstrate the following competencies:
  • Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations.
  • Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
  • Team Work - Supports everyone's efforts to succeed.

Qualification Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:

High school diploma or general education degree (GED); or 1-2 years related experience and/or training; or equivalent combination of education and experience.