Claims Assistant

Company Details

As a specialty workers’ compensation insurance company, our success is due in large part to the meaningful relationships we have developed with over 17,000 policyholders and hundreds of insurance brokers over the years and, by being responsive to the workers’ compensation insurance needs of our policyholders.

Responsibilities

The Claims Assistant reports to the Claims Operations Manager, is under moderate supervision and utilizes general understanding of department’s operation and objectives to provide administrative support and queue management related to claim payments, bill inquiries, coordination assistance and customer service to the claims department. Additionally, this position will train and mentor less experienced staff including modeling company core values, principles and guidelines. This position will answer general claim payment questions from customers and will act as a liaison for technical staff and internal/external customers in response to routine inquiries. Job functions are considered routine and predefined and require minimum evaluation. Claims financial processing activities will be conducted in compliance with the rules, regulations, and statutes of the WCAB and the State of California. The Senior Claims Assistant must be a team player. This position requires particular attention to detail, ability to reprioritize and is often task-oriented.

Key functions include but are not limited to the following:

• Manage assigned work queues by distributing and assigning total open activities evenly among the Unit’s team members.
• Serve as process owner and backup to departmental work queues, as assigned.
• Mentor and train less experienced staff as needed.
• Ensure work is completed promptly and within department’s goals and objectives.
• Provide customer service – answer telephones by the third ring and re-direct callers as necessary to properly respond to customer inquiries.
• Provide backup coverage during team member absences.
• Assist in the administration of claims by making follow up status calls to providers.
• Perform data entry to work diaries and create activity notes.
• Complete assigned work via diaries and work queues in a timely manner.
• Promptly escalate queue management issues affecting department timelines.
• Respond to all requests and inquiries from claims staff, vendors, and others as appropriate.
• Perform other duties as requested by the Claims Operations Manager or Claims leadership team.

Qualifications

• 4-year degree required or knowledge of workers’ compensation principles and policies equivalent preferred.
• 5 years of related administrative office work experience.
• Strong written and verbal communication skills, attention to detail and deadline structures.
• Ability to work in a fast-paced environment both independently and collaboratively with all levels of staff.
• Proficient with MS Office software and PC applications and systems

Additional Company Details

Additional Requirements