Claims Assistant

Responsibilities

• Organizes the digital claim records for uniformity by removing duplicate records and top-lining documents
• Completes 10-day and 6-month claim maintenance checklists to ensure the highest level of claims statistical data processing
• Processes corrections to data error crits as required
• Completes manual Medicare query of claims at the CMS COB&R site as needed and documents the digital claim record
• Processes class code corrections that accurately depict the scope of an injured workers’ job and payroll
• Completes claim documents in both Image Right and Powersuite
• Completes closure, re-opens, and reassignments of all claim files as submitted by Supervisory personnel
• Assists with record subpoenas and completes lien reviews organized with a worksheet summary
• Completes vendor referrals by service specialty and utilization review submissions to Rising
• Maintains contact with the WCAB for status updates on claims where named as a party to suit in error
• Complies with Maximus responses following IMR for timely fulfillment
• Reviews adjuster Image Right tasks daily for medical authorization requests
• Provides administrative assistance to claim adjusting team members as needed
• Provides back-up in the entry of manual payments to the Claims Payable Analyst

• Minimum Education:
  
  High School Diploma or equivalent
• Preferred Education:
  
  College degree preferred
• 1-2 years of relevant claims processing experience preferable in the worker’s compensation field or similar experience
• Thorough knowledge of workers’ compensation claims procedures and policies
• Professional telephone demeanor, good verbal and written communication skills, good listening skills
• Strong organizational skills
• Ability to type 45 WPM
• Basic understanding of business technology