Claims Assistant, WC

Overview

Responsible for assisting Examiners in every aspect of claims administration. The Claims Assistant will identify, prevent and mitigate potential penalties as well as deliver 3 point contact.

Responsibilities

Keenan is a successful insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. Keenan specializes in providing consulting services in the areas of: employee benefits, workers' compensation, loss control, financial, and property & liability. We have seen continuous growth and success, and are positioned to lead the industry into the 21st century. Keenan continues to grow at a rapid pace, and so do the opportunities for our current and future employees.   Keenan has an exciting career opportunity for a Claims Assistant in the Workers Compensation department. This position will be remote and operating on Pacific Standard Time. The Claims Assistant will be responsible for assisting Examiners in every aspect of claims administration.  The Claims Assistant will also identify, prevent and mitigate potential penalties as well as deliver 3 point contact.   ESSENTIAL DUTIES AND RESPONSIBILITIES include the following: - Input data entry on all new claims. - Provide indemnity payments and cycles. - Request wage statements and wage statement calculations. - Identify, prevent and mitigate potential penalties. - Deliver 3-point contact (MO &/or Indemnity files) to verify the mechanics of the injury, compensability and discharge. - Review all DWC letters (initial notices). - Input form letters (30 day closing letters when appropriate). - Calculate and pay mileage and benefits. - Verify lost time and waiting periods. - Review and manage modified duty. - Perform maintenance of current diary. - Input basic notes relating to claim, status and treatment. - Identify issues requiring conversion to Indemnity to include supporting documentation. - Refer all x-rays and diagnostic services to PRIME for utilization review. - Process medical bills daily to avoid penalty and interest. - Investigate all questionable claim circumstances and refer to the examiner when needed. - Maintain 100% closing ratio. - Return phone calls within 24 hours. - Review mail/bills daily – paperless system. - Correct error report daily. - Maintain client/claimant satisfaction. - Perform indemnity payments and cycles. - Input all DWC (Division of workers’ compensation) letters (notice, including denials). - Process QME (Qualified medical evaluator) to receipt of report. - Type Stipulations, mail to employee and WCAB (Worker’s compensation appeals board). - Type Compromise & Release and mail to the employee and WCAB. - Schedule appropriate medical appointments, calculate mileage, and send appointment letters. - File and serve appropriate documents. - Complete investigation and copy service request forms. - Refer all PRIME deletions to office designee only. - Complete IMR (Independent Medical Review) and process in a timely and accurate manner. - Interact with nurse on case management regarding return to work status. - Maintain and update Work Status tab. - Input statute letters, delay letters, or any other required initial letter. - Interaction with nurse on case management regarding return to work status. - Other duties as assigned.   MINIMUM SUGGESTED QUALIFICATIONS: - Minimum of one (1) year of Claims Assistant experience required. - Ability to multitask, communicate effectively in writing and verbally, within all aspects of job requirements. - Experience in insurance and/or Workers Compensation claims is preferred.   SOFTWARE: Proficient in Microsoft Outlook, Excel, PowerPoint and Word.  Adept at accessing business data from the Internet when required.     COMPENSATION AND BENEFITS:   - The target salary range for this position is $38,000.00 - $52,000.00 (US Dollar) annually. The actual salary will vary based on applicant’s education, experience, skills, and abilities, as well as internal equity and alignment with market data. The salary may also be adjusted based on applicant’s geographic location.   - Keenan offers a competitive benefits package including, but not limited to, medical, dental, vision, voluntary benefits, 401(k) with a company match, generous paid-time off and holidays. - Remote work environment flexibility.

Salary : $38,000 - $52,000