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Workers' Compensation Claims Assistant

Job Description:

Workers' Compensation Claims Assistant
The Workers' Compensation Claims Assistant is responsible for providing technical and clerical assistance to claims examiners and managing workers' compensation medical only claims.

Supervision Received
This position receives direct supervision from the Workers' Compensation Claims Manager.

Essential Duties and Responsibilities
Responsibilities and duties may include, but are not limited to the following:
• Perform technical and clerical support functions for and/or at the request of claims examiners: 
• Issue benefit checks and 4850 vouchers, upon approval by claims examiner
• Prepare and send various letters and benefit notices
• Obtain wage statements and calculate earnings and benefit rates
• Make initial contacts on new claims to gather information regarding AOE/COE issues, explain benefits and determine disability status; document information in claim notes
• Approve medical and non-medical invoices according to policy
• Respond to injured employees and members regarding claims questions or issues
• Maintain current and specific documentation of activities in the claim notes
• Review and manage mail and diary on a daily basis
• Oversee the submission of claim data to the state WCIS system, including accurate and timely submission of FROI and SROI reports, and response to any data errors
• Submit Medicare query and report secure electronic data files, and process electronic data file responses from Medicare.

Handle all aspects of medical only claims, including:
• Appropriate reserves, Current diary
• Timely response to requests for authorization of treatment
• Oversight of outside providers, including nurse case managers
• Identify possible subrogation, AOE/COE or indemnity issues and refer to claim examiners when appropriate
• Review medical bills for accuracy
• Participate in conferences and seminars as deemed necessary by Workers' Compensation Manager to continue education about the workers' comp system and maintain state- mandated medical only claims adjuster designation status
• Perform other file duties as assigned by the Manager

Requirements:

• Good written and verbal communication skills, including knowledge of spelling, grammar and punctuation
• Exceptional customer service skills, including active listening and problem solving
• Modern office procedures and equipment, including filing systems, telephone techniques and computer systems including Microsoft Office products
• California Workers' Compensation laws, regulations and claims handling procedures necessary to perform functions of job
• Basic medical terminology
• Ability to interpret specific laws, rules and policies necessary for the administration of claims, and apply them using good judgment
• Apply mathematical skills to calculate earnings and benefit amounts
• Establish and maintain cooperative and effective working relationships, both internally and externally
• Plan and organize activities to meet all deadlines and complete work timely
• Communicate clearly and concisely
• Review and understand medical reports
• Type with sufficient speed and minimal errors, as necessary to successfully perform the job
• Comply with continuing education requirements

Physical Requirements
The conditions herein are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions. Primary functions require sufficient physical ability and mobility to work in an office setting; to stand or sit for prolonged periods of time; daily repetitive bending, stooping, crouching, reaching and kneeling; ability to lift, carry, push, and/or pull light to moderate amounts of weight; to operate office equipment requiring repetitive hand movement and fine coordination including use of a computer keyboard; and to verbally communicate to exchange information. Reasonable accommodations may be provided upon request.

Minimum Qualifications
Education / Training High School diploma or general education diploma.

Experience
A Minimum of two years of experience as a workers' compensation claims assistant including handling workers' compensation medical only claims. Experience with self-insured public agency claims administration preferred but not required.

License/Certifications
Valid California Driver's License. Must meet workers' compensation claim adjuster training standards pursuant to Title 10, Chapter 5, Subchapter 3, Section 2592.02, meaning either three years within the past five years of on-the- job experience adjusting California workers' compensation medical only claims or self-insurance administrator's certification or at least 80 hours of qualified training or any combination thereof. If this requirement is not met, may be hired as a trainee and required to immediately engage in training to meet the statutory requirements within one year of assuming the position, while working under the direct supervision of the manager.

Application Procedures:

ALL APPLICANTS MUST FILL OUT AN EMPLOYMENT APPLICATION. To obtain an application, visit www.mpa-nc.com Please submit your completed EMPLOYMENT APPLICATION, RESUME, and COVER LETTER to info@mpa-nc.com. Please include the title of the position you are applying for in the subject line of the email. You may also mail your Employment Application, resume, and cover letter to: Attn: Workers' Compensation Dept Municipal Pooling Authority PO Box 67 Walnut Creek, CA 94597