Workers Compensation Claims Assistant I

Summary:

Reports directly to the unit Claims Supervisor but takes primary direction for the assigned Claims Specialist(s). Responsible for providing clerical operations support to assigned Claims Specialist(s).

Essential Duties and Responsibilities:

• At the direction of the Claims Specialist, verifies wage information by soliciting wage statements, prepares request for ratings from the DEU, issues subpoena for records, closes files, and handles legal referrals.
• Maintains a diary on all claims with regularly scheduled benefit payments, including TD, PD, VRMA, and death benefits to assure that the payments are made timely.
• Communicates with employers, injured workers, and medical providers to verify return to work status prior to the issuance of each benefit payment and arranges for medical examinations at the request of the Claims Specialist.
• Assures that benefits are paid in the correct amounts and at the proper time in accordance with applicable statutes and company operating standards.
• Responsible for the timely payment of mileage reimbursements to injured workers and also the payment of deposition fees for applicant’s attorneys.
• At the request of the Claims Specialist completes and mails appropriate benefit notices including rehabilitation related notices and letters in accordance with applicable statutes.   
• Under the direction of the Claims Specialist, solicits medical reports and other correspondence needed to verify disability status, types and mails various documents including stipulations, and takes care of legal referrals.
• Accurately enters benefit payments and other required data into the claims system in the appropriate fields.
• Promptly responds to direction and requests for assistance from the Claims Specialist or the Supervisor.
• Presents a knowledgeable, professional, and helpful image on behalf of the company.
• Respond to all phone calls and inquiries no later than 24 hours after receipt.
• Respond to written correspondence within five working days of receipt. 
• Handles other duties and tasks as deemed appropriate by the Claims Specialist, Supervisor or Manager.

Competency:

To perform the job successfully, an individual should demonstrate the following competencies: 

• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations. 
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments. 
• Team Work - Supports everyone's efforts to succeed.

Qualification Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

Education and/or Experience:

High school diploma or general education degree (GED); 2-5 years related experience and/or training; or equivalent combination of education and experience.

We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.