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Assistant Claims Examiner (Medical Only Claims)
Los Angeles, CAPOSITION DETAILS
POSITION SUMMARY
COMPANY has an immediate need for an experienced Assistant Claims Examiner to support our Workers’ Compensation department and can be located anywhere in the state of California, but if the employee lives within 26 miles of the office address they will be required to work a hybrid. The employee must reside in California. The schedule for this position is Monday-Friday at 37.5 hours a week with the option of a flex schedule. The Assistant Claims Examiner will provide clerical and technical assistance to Senior Claims Examiners and administer Medical Only claims, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, and setting reserves.
PRIMARY RESPONSIBILITIES
Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:
The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.
This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training.
COMPANY is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.
THANK YOU!
POSITION SUMMARY
COMPANY has an immediate need for an experienced Assistant Claims Examiner to support our Workers’ Compensation department and can be located anywhere in the state of California, but if the employee lives within 26 miles of the office address they will be required to work a hybrid. The employee must reside in California. The schedule for this position is Monday-Friday at 37.5 hours a week with the option of a flex schedule. The Assistant Claims Examiner will provide clerical and technical assistance to Senior Claims Examiners and administer Medical Only claims, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, and setting reserves.
PRIMARY RESPONSIBILITIES
Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:
- Process new claims in compliance with client’s Service Agreement
- Issue all indemnity payments and awards on time
- Process all approved provider bills timely
- Prepare objection letters to providers for medical bills; delayed, denied, lacking reports.
- Answer questions over the phone from medical providers regarding bills
- Contact treating physician for disability status
- Contact employer for return-to-work status or availability of modified work.
- Contact injured worker at initial set up
- Send DWC notices timely
- Issue SJDB Notices timely
- Request Job Description from Employer
- Handle Medical Only claim files
- Calculate wage statements and adjust disability rates as required
- Keep diary for all delay dates and indemnity payments
- Documents file activity on computer
- Update information on computer, i.e., address changes, etc.
- Schedule appointments for AME, QME evaluations
- Send appointment letters, issue TD/mileage, send medical file
- Schedule interpreter for appointments, depositions, etc.
- Request Employer’s Report, DWC-1, Doctor’s First Report if needed
- Verify mileage and dates of treatment for reimbursement to claimant
- Subpoena records
- File and serve documents on attorneys, WCAB, doctors
- Serve PTP’s with medical file and Duties of Treating Physician (9785)
- Request PD ratings from DEU
- Draft Stipulated Awards and C&R’s
- Submit C&R, Stipulated Awards to WCAB for approval with documentation
- Process checks – stop payment, cancellations, void, journal payments
- Handle telephone calls for examiner as needed
- Complete penalty calculations and prepare penalty worksheets
- Complete MPN, HCO and/or EDI coding
- Complete referrals to investigators
- Complete preparation of documents for overnight delivery
- Work collaboratively with Senior Claims Examiners, Nurse Case Managers, and other Assistant Claims Examiners
- Contact with clients, injured workers, attorneys, doctors, vendors, and other parties
- Provide updates of claims status to Senior Claims Examiners and COMPANY management
- Prepare professional, well written correspondence and other communications
The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.
- High School Diploma or equivalent (GED) required for all positions
- AA/AS or BA/BS preferred but not required
- 2+ years’ Claims Assistant experience supporting a workers compensation examiner or team preferred
- Medical Only Adjuster designation strongly preferred
- Medical Only Adjuster designation required after hire
- Continuing hours must be current
- Mathematical calculating skills
- Completion of IEA or equivalent courses
- Administrators Certificate from Self-Insurance Plans preferred
- Knowledge of workers compensation laws, policies, and procedures
- Understanding of medical and legal terminology
- Must demonstrate accuracy and thoroughness in work product
- Ability to sit for prolonged periods of time
- Well-developed verbal and written communication skills with strong attention to detail
- Excellent organizational skills and ability to multi-task
- Ability to type quickly, accurately and for prolonged periods
- Proficient in Microsoft Office Suite
- Ability to learn additional computer programs
- Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
- Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization
- Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
- Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner
- Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor
- COMPANY’ operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.
- Must be able to reliably commute to meetings and events as required by this position
This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training.
COMPANY is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.
THANK YOU!