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California Claims Assistant

2 months ago

Irvine California, United States CCMSI Full time
About the Role

We are seeking a highly skilled and detail-oriented Claims Assistant to join our team at CCMSI. As a Claims Assistant, you will play a critical role in providing administrative support to our team of California Workers' Compensation Claim Adjusters.

Key Responsibilities
  • Investigate and evaluate contested medical-only claims and handle indemnity cases under close supervision.
  • Establish reserves and/or provide reserve recommendations within established authority levels under direct supervision.
  • Set up designated claim files and complete all setup instructions as requested.
  • Set up independent medical exams as deemed necessary under direct supervision.
  • Request and monitor medical treatment of designated claims in accordance with corporate claim standards.
  • Review and approve related medical, legal, damage estimates, and miscellaneous invoices on designated claims.
  • Negotiate any disputed bills/invoices for resolution under direct supervision.
  • Negotiate settlements in accordance with Corporate Claim Standards, client-specific handling instructions, and state laws under direct supervision, when appropriate.
  • Make referrals to outside vendors on designated cases under direct supervision.
  • Effective and timely coordination of communication with clients, claimants, and other appropriate parties throughout the claim adjustment process.
  • Authorize and make payments on claims utilizing a claim payment program in accordance with industry standards and within established authority levels under direct supervision.
  • Compute disability rates in accordance with state laws under direct supervision, when appropriate.
  • Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim.
  • Return provider calls.
  • Review and maintain personal diary on claim system.
  • Provide technical and clerical claims support to designated clients, as requested.
  • Compliance with corporate claim standards and special client handling instructions as established.
Requirements
  • Excellent oral and written communication skills.
  • Individual must be a self-starter with strong organizational abilities.
  • Ability to coordinate and prioritize required.
  • Ability to operate general office equipment and perform clerical duties.
  • Flexibility, initiative, and the ability to work with a minimum of direct supervision a must.
  • Discretion and confidentiality required.
  • Ability to work as a team member in a rapidly changing environment.
  • Reliable, predictable attendance within client service hours for the performance of this position.
  • Responsive to internal and external client needs.
  • Ability to clearly communicate verbally and/or in writing both internally and externally.
Education and Experience
  • Associate's degree or two year's related business experience.
  • Knowledge of medical terminology preferred.
Computer Skills
  • Proficient with Microsoft Office programs.