What are the responsibilities and job description for the Claims Assistant position at Puzzle HR?

Job Description

Overview

Now Hiring! : Claims Assistant

Location : Spring Valley, NY 10977

Compensation : $25 - $30 per hour

What's in it for You :

Medical, Dental, Vision Benefits
Competitive Compensation
401K eligible upon 1st day of employment
FSA & DCA Accounts
Career advancement opportunities in an expanding company

Job Summary : Claimsake is efficient workers’ comp claims management and support from report to resolution presented by Highview National Insurance, an insurance carrier that provides workers’ compensation coverage. We pride ourselves on having an exceptional team environment, with multiple avenues for growth opportunities. The Claims Assistant will be responsible for investigation, and management of medical only and lower-level workers’ compensation indemnity claims in multiple jurisdictions. This will include medical management and litigation management to drive claims to closure while working to actively mitigate exposure for the Company. As Claims Assistant , you will coordinate between insureds, brokers, nurse case managers, defense counsel, and external vendors to ensure efficient and pro-active claims handling.

Essential Job Functions :

Responsible for completing and documenting initial loss investigations on low and midlevel workers compensation claims to determine compensability under close

supervision.

Under direction and guidance of the claim supervisor, establish initial and subsequent reserves to ensure reserves are adequate for anticipated exposure with increasing degrees of responsibility and complexity.

Review and approve medical bills for causal relationship to reported claim.

Liaison with insureds, nurse case managers, and counsel to oversee management of claims and bring them to closure and facilitate full or transitional duty return to work.

Responsible for EDI and other claims coding functions along with data entry and report generation.

Respond to inquiries and request for information from insureds, brokers, medical providers and other external parties.

Under close supervision, prepare and present claim review summaries for insureds, brokers, internal contacts as requested.

Participate in roundtable discussions internal colleagues, insureds, and counsel on strategies for successful claim closure / resolutions.

Support other members of the claims department with larger or more complex claims as assigned.

Under supervision of claims supervisor assist the insured onboarding process including training on claims reporting and the use of the insured portal.

Performs other duties as assigned.

Required Skills / Abilities / Experience :

High School Diploma or equivalent (Associate's or Bachelor's degree preferred).

Minimum of three (3) years of experience in worker's compensation, claims management, or administrative role is preferred.

Previous experience in workers' compensation claims management, specifically medical-only claims, is preferred.

Proficient in Microsoft Office and has an aptitude to learn other software applications.

Excellent oral and written communication skills.

Detail oriented with a high accuracy rate.

Ability to problem solve and use good judgment.

Self-motivated with excellent time management skills.

Onsite presence at our office in Spring Valley, NY required.

This list of functions, duties, responsibilities, and skills is not intended to be all-inclusive, and the employer reserves the right to assign additional duties and responsibilities as necessary.

Claimsake is an Equal Opportunity Employer. Claimsake does not discriminate based on race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status, or any other basis covered by appropriate law. All employment is decided based on qualifications, merit, and business need.

Salary : $25 - $30

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