Claims Assistant

Overview

The Claims Assistant is responsible for assisting Examiners in every aspect of claims administration.

Responsibilities

AP Keenan, an AssuredPartners company, is a successful insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. AP 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. Together, with AssuredPartners, we continue to grow at a rapid pace, and so do the opportunities for our current and future employees.   This is a remote position operating on Pacific Time.   SUMMARY:  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.   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. - Request wage statement and wage statement calculations. - 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.