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 ImageRight 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 ImageRight 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

Claims Assistant

Key skills