Insurance Claims Representative

The following is a summary of the responsibilities of the Claims Representative in the Diocesan Fiscal Office:

The Claims Representative should have a working knowledge of the NYS Workers Compensation Self Insurance Law and Procedures, and Workers Compensation Claim Handling, Laws and Procedures.

Working knowledge of the following systems/software:

• Risx-Facs (Training Module Provided)
• All Facets of Microsoft Office (Excel, Publisher, etc)
• Access
• AssetMax (Training Module Provided)
• Gallagher Bassett Service Portal (Training Module Provided)
• NYS E-Case
• NYS E-Claims
• NYS WCB Website

Multi line insurance responsibilities:

• Prepare insurance renewal applications for account producer

1. Run applicable reports from our Access Data Base

2. Complete and obtain all information for excess applications

3. Coordination with inflating current building values

4. Prepare excel spreadsheets with data obtained from Access database, AssetMax database and need specific info from locations to create need specific reports

• New York State Public Goods Pool Report

1. Prepare annual report to NYS for surcharges

2. Coordination of medical bill review to assure surcharges due

3. Updates on new requirements

• Maintain Protected Self-Insurance Program Access Data Base & prepare premiums to participating locations

1. Update auto data in preparation of July 1 premium billing

2. Request prior year employee wages by classification from all location and input new salary data for lay staff (diocesan wide) in preparation of July 1 billing

3. Update building and property data in preparation of July 1 billing each appraisal year

4. Obtain rates from New York Compensation Insurance Rating Board (NYCIRB)

5. Issue debits/credits to locations whenever there is a change in autos, property and liability throughout the year.

• Run all Risx-Facs Reports to support Fiscal and Insurance Office

1. Downloading reports from Gallagher Bassett website for diocesan bookkeeping staff daily, monthly, quarterly and annually

2. Build queries for specific reporting purposes from Access database and Risx-Facs database

3. Research claim information on Gallagher Bassett website

4. Prepare excel spreadsheets with data obtained from Access database and Risx-Facs database to create need specific reports

Workers' Compensation Insurance Responsibilities:

1. As part of the WC responsibilities this position requires a complete understanding of the vast NYS Compensation Laws.

2. Set up workers’ compensation claims with TPA through GB Portal

3. Monitor all claim activity with TPA

4. Contact with employer, treating physicians, claimants, attorneys and TPA throughout claim:

• Obtain information from employers for proper completion of C-2, C-11, and C-240 and forward to TPA and WCB
• Work with attorneys during settlement issues
• File all forms timely to avoid penalties
• NYS electronic filing and electronic case folder (ecase) to file forms and monitor file
• Assist TPA with Investigation
• Pay all related medical bills according to NYS Workers’ Compensation Fee Schedule on closed claims
• Monitor claim reserves and total experience when reviewing Status reports
• Advise TPA of employee background, work ethic, etc
• Assure assessments to NYS, report and pay
• Compliance with the Workers’ Compensation Board Bureau of Compliance
• Work with physicians and employers to return employee to work as soon as possible
• Communicate with physicians and employers for possible Return to Work light duty
• Continually research Workers’ Compensation Board website for law and procedural changes
• Research and audit private carrier and Medicaid reimbursement requests (per WCB HIMP)
• Continually keep up-to-date on the WC Medical Treatment Guidelines
• Forward medical bills for price review to Q.R. Concepts and issue checks to mail with Explanation of Benefits on all bills once returned
• Monitor weekly the NYS Division of Administrative Rules for proposed changes to laws that affect the Diocese and the Self-Insured Program
• Continually monitor TPA file notes regarding handling of claims
• Respond to TPA inquiries regarding claim handling, authorizations, reserve increases, etc.

Auto Insurance Responsibilities:

• New York State Self-Insurance Auto Application
• Keep track of all diocesan vehicles
• Coordinate vehicle changes (addition/remove)
• Issue insurance ID cards
• Assist Claims Manager with subrogation claims

Property/Liability Insurance Responsibilities:

• Support Claims Manager with files
• Answer questions to PSIP participating locations
• Request Certificates of Insurance
• Issue Certificates of Insurance
• Keep track of all diocesan property for PSIP data base

NYS Worker’s Compensation Self-Insurance Program Responsibilities

• Compile claims status information and paid to date information by accident year on all open files and all files closed during the year
• File reports indicating cumulative medical and indemnity payments made during the policy year; provide payroll for all locations by classification
• Compile all information and run Risx-Facs reports for Actuarial Review
• Compile Risx-Facs and Access reports to file quarterly electronic assessment reports GA-1.6, GA-3, and GA-5 with the WCB Self-Insurance Office

Miscellaneous Tasks:

• Work with IT Coordinator to continually update Insurance Office postings on the Pastoral Documentation Site
• Prepare all outgoing mail for US Postal Office, UPS, FedEx
• Copy work
• Office supply inventory
• Screen all incoming mail and injury/accident reports
• Create Risk Management Newsletter in conjunction with diocese’s Insurance Risk Manager
• Compile reports requested during audit

Support to Insurance Manager:

• Word processing
• Set up files
• Answer telephone, take messages
• Open and distribute mail
• Risx-Facs Software support
• Provide support for Access database
• Provide support for Asset Max database
• Provide support for Microsoft and Outlook
• Voucher all payments to fiscal office
• Voucher all excess and subrogation reimbursements to fiscal office

Job Type: Full-time

Pay: $44,815.00 - $54,581.00 per year

Benefits:

• Health insurance
• Life insurance
• Paid time off
• Retirement plan

Schedule:

• Monday to Friday

Experience:

• Microsoft Office: 2 years (Required)
• Customer service: 2 years (Required)

Ability to Relocate:

• Ogdensburg, NY 13669: Relocate before starting work (Required)

Work Location: In person

Salary : $44,815 - $54,581