Overview We are seeking a detail-oriented and organized Workers Compensation Claims Service Assistant to join our team. This role involves reviewing and setting up new medical and lost time claims. Determining liability and coverages. Investigating claims as necessary. Paying claims or denying claim payment. Assisting claimants, insureds, and other parties with claim related questions while providing excellent customer service. Responsibilities Promptly set up new medical only & lost time files in claims system and send acknowledgment letter or email to insured in timely manner advising of claim number. Establish initial reserves on new claims and continue to monitor reserves to conclusion of claim. Accurately enter indemnity and medical checks into claims system. Enters voided, recovery and manual checks into computer system as appropriate. Manage various claims questions, coverage questions and other inquiries via telephone. Develops correspondence to claimants, providers, physicians, etc. as appropriate. Prepare claim denial letters and send to appropriate parties. Promptly and professionally reply to emails, faxes and written correspondence. Complete state forms in assigned states. Timely submit claim information electronically to the various states. Investigate claim to determine compensability. Investigation may require interviewing claimants and witnesses. Discuss questionable claims with manager. Manage file using diary system to ensure timely return to work status, maximum medical improvement, and file closure. Evaluate claims for best possible outcome Recognize files with subrogation potential & pursue reimbursement. Participate in industry conferences, webinars, outreach meetings & medical seminars. When appropriate, assign files to nurse case manager, defense attorney, cost containment vendors and independent adjuster to assist with managing claim. Accurately complete transactions regarding Medicare beneficiaries. Qualifications Prior clerical experience preferred, especially in insurance or medical billing environments Strong organizational skills with the ability to manage multiple tasks efficiently Knowledge of medical terminology and medical documentation standards. Familiarity with workers' compensation law and procedures is beneficial. Excellent attention to detail and communication skills to ensure accuracy in all aspects of claims management This position is essential for ensuring the smooth processing of workers' compensation claims while maintaining compliance with industry standards. We welcome candidates who are committed to accuracy, organization, and providing outstanding service within a collaborative team environment.

EEO Employer/Disabled/Protected Veteran Job Type:

Full-time Pay:

From $19.50 per hour

Benefits:

401(k) 6% Match 401(k) matching Dental insurance Employee assistance program Flexible schedule Health insurance Health savings account Life insurance Matching gift program On-site gym Paid time off Prescription drug insurance Referral program Retirement plan Vision insurance

Work Location:

In person