Claims Assistant

Claims Assistant

Posting will remain active until positions are filled

EOE

Summary

The Claims Assistant performs tasks to provide support to the Work Injury Adjuster. The statements contained herein reflect general details to describe the key functions of this job, the level of knowledge and skill typically required, but should not be considered an all-inclusive listing of work requirements. Individuals may perform other duties as assigned, including work in other functional areas to cover absences, to equalize peak work periods or otherwise to balance the workload.

Essential Functions

Maintain punctuality and attendance as outlined in the Time and Attendance Policy

Enter New Claims emailed to you by your IBC.

Mail template letter to medical providers advising of billing information.

Talk with / Email medical providers regarding work status and medical records. Email is preferred method for efficiency.

Close Express Scripts and handle incoming prescription approval requests

Manage returned mail for assigned client by taking appropriate steps to redirect mail to the claimant

Update information in various claim system fields as directed by the IBC

Handle non-positive needle stick claims once the injured worker has been placed at full duty when assigned by the IBC

Close claims at final payment or with 60 days of inactivity as described in the Pertinent Claim Requirements.

Occasional client contact (i.e. request for IBA, injury reports and forms, HIPAA, hourly rate, wage history, hire date, term date if applicable, etc.)

Assist IBC with simple welfare calls only when claimant is on modified duty or off work without complexities once per month as directed by IBC. These monthly welfare calls are not necessary for claimants who are working full duty or when NCM is communicating with claimant.

Nurse case management contact to request notes, reports, etc. when directed by IBC.

When directed by IBC, provide demographics, prepare NCM/Med Director referrals and communicate with nurse/assistants.

Prepare and submit check request forms at direction of IBC once calculations have been determined by the IBC

Review and document ISO findings if claim exceeds 120 days of active treatment status. If there are ISO matches, set diary for IBC review.

Provide authorization for treatment to clients/doctors as directed by the IBC

Follow-up on No Claims correspondence to request injury report / claim.

Maintain appropriate follow-up diary

Strictly follow customized client protocols

Respond to direction within 24 hours to communicate completion or prohibiting completion of direction

Additional duties or projects as assigned by management

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

Achievement Focus – demonstrates persistence and overcomes obstacles; measures self against standard of excellence; recognizes and acts on opportunities

Adaptability – Adapts to changes in the work environment; manages competing demands; able to deal with frequent change, delays, or unexpected events; changes approach or method to best fit the situation

Attendance and Punctuality – Is consistently at work and on time; ensures work responsibilities are covered when absent; arrives at meetings and appointments on time; adheres to Providence’s time and attendance policy

Business Acumen – understands business implications of role and overall organization

Communications – expresses ideas and thoughts verbally; expresses ideas and thoughts in written form; exhibits good listening and comprehension; keeps others adequately informed; selects and uses appropriate communication methods

Conflict Resolution – Encourages open communications; maintains objectivity; keeps emotions under control

Continuous Learning – assesses own strengths and weaknesses; seeks feedback to improve performance; strives to continuously build knowledge and skills; shares expertise with others.

Cooperation – Establishes and maintains effective relations; exhibits tack and consideration; offers assistance and support to co-workers; works cooperatively in group situations

Cost Consciousness – conserves organizational resources

Customer Service – Manages difficult or emotional customer situations; responds promptly to customer needs; responds to requests for service and assistance, meets commitments

Dependability – Follows instructions, responds to management direction; takes responsibility for own actions; completes tasks on time and/or notifies supervisor or manager if needs assistance prior to deadline being missed

Diversity – Shows respect and sensitivity for differences, promotes a harassment-free environment

Ethics – Treats people with respect, keeps commitments; inspires the trust of others; works with integrity and principles; upholds organizational values

Initiative – Volunteers readily; seeks increased responsibility; asks for and offers help when needed

Innovation – generates suggestions for improving work performance

Judgment – exhibits sound and accurate judgment; supports and explains reasons for decisions;

Job Knowledge – Competent in required job skills and knowledge; exhibits ability to learn and apply new skills; displays understanding of how job relates to others; uses resources effectively

Oral Communication – Listens and gets clarification; responds well to questions; participates in meetings

Organizational Support – Follows policies and procedures; completes administrative tasks correctly and on time; supports organizational goals and values

Personal Appearance – adheres to Providence’s Personal Appearance Policy; keeps self well groomed

Planning and Organizing – Prioritizes and plans work activities; uses time efficiently; sets goals and objectives

Problem Solving – gathers and analyzes information skillfully, identifies and resolves problems in a timely manner; works well in group problem solving situations; uses reason even when dealing with emotional topics

Quality – Demonstrates accuracy and thoroughness; applies feedback to improve performance; monitors own work to ensure quality

Quantity – Meets productivity standards; completes work in timely manner; ability to work in a fast-paced, multitasked environment; strives to increase productivity

Safety and Security – uses equipment and materials properly

Teamwork – Balances team and individual responsibilities; exhibits objective and openness to other’s views; gives and welcomes feedback in a respectful, professional manner; contributes to building team spirit; puts success of team above own interests; supports everyone’s efforts to succeed

Use of Technology – demonstrates required skills; adapts to new technologies; uses technology to increase productivity; ability to adapt to and work in a paperless environment

Written Communication –writes clearly and informatively; edits work for spelling and grammar; presents numerical data effectively; able to read and interpret written information

Qualifications 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 Experience

High school diploma or general education diploma (GED);

Six months to one year related experience and/or training

Language Skills

Ability to read and interpret documents. Ability to write routine reports and correspondence. Ability to speak effectively before groups of people.

Reasoning Ability

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Computer Skills

Ability to learn and utilize industry specific computer software

Knowledge of File Handler System a plus

Knowledge of MS Word and Outlook

Type 32 WPM

Work Conditions

The demands described are representative of those that must be met by staff members to successfully perform the essential functions of this job. Reasonable accommodations may be made for individuals with disabilities to perform essential functions.

May work more than 40 hours per week

Monday – Friday, 8.5 hour, day shift, one hour lunch; may work weekends and/or evenings based on business needs, with prior manager approval.

Ability to operate computer and other office equipment such as keyboard, phone, copy machine, etc.

Must be able to remain in stationary position (excluding breaks/lunch)

The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc.

Able to perform job in an environment with low to moderate noise and/or level of distractions

Occasionally move up to 10 pounds