AP Keenan, an AssuredPartners company, is a successful insurance brokerage and consulting firm meeting the insurance needs of hospitals, public entities and California school districts. AP Keenan specializes in providing consulting services in the areas of: employee benefits, workers' compensation, loss control, financial, and property & liability. We have seen continuous growth and success, and are positioned to lead the industry into the 21st century. Together, with AssuredPartners, we continue to grow at a rapid pace, and so do the opportunities for our current and future employees.
This is a remote position operating on Pacific Time.
SUMMARY: Responsible for assisting Examiners in every aspect of claims administration. The Claims Assistant will identify, prevent and mitigate potential penalties as well as deliver 3 point contact.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:
- Input data entry on all new claims.
- Provide indemnity payments and cycles.
- Request wage statements and wage statement calculations.
- Identify, prevent and mitigate potential penalties.
- Deliver 3-point contact (MO &/or Indemnity files) to verify the mechanics of the injury, compensability and discharge.
- Review all DWC letters (initial notices).
- Input form letters (30 day closing letters when appropriate).
- Calculate and pay mileage and benefits.
- Verify lost time and waiting periods.
- Review and manage modified duty.
- Perform maintenance of current diary.
- Input basic notes relating to claim, status and treatment.
- Identify issues requiring conversion to Indemnity to include supporting documentation.
- Refer all x-rays and diagnostic services to PRIME for utilization review.
- Process medical bills daily to avoid penalty and interest.
- Investigate all questionable claim circumstances and refer to the examiner when needed.
- Maintain 100% closing ratio.
- Return phone calls within 24 hours.
- Review mail/bills daily – paperless system.
- Correct error report daily.
- Maintain client/claimant satisfaction.
- Perform indemnity payments and cycles.
- Input all DWC (Division of workers’ compensation) letters (notice, including denials).
- Process QME (Qualified medical evaluator) to receipt of report.
- Type Stipulations, mail to employee and WCAB (Worker’s compensation appeals board).
- Type Compromise & Release and mail to the employee and WCAB.
- Schedule appropriate medical appointments, calculate mileage, and send appointment letters.
- File and serve appropriate documents.
- Complete investigation and copy service request forms.
- Refer all PRIME deletions to office designee only.
- Complete IMR (Independent Medical Review) and process in a timely and accurate manner.
- Interact with nurse on case management regarding return to work status.
- Maintain and update Work Status tab.
- Input statute letters, delay letters, or any other required initial letter.
- Interaction with nurse on case management regarding return to work status.
- Other duties as assigned.
MINIMUM SUGGESTED QUALIFICATIONS:
- Minimum of one (1) year of Claims Assistant experience required.
- Ability to multitask, communicate effectively in writing and verbally, within all aspects of job requirements.
- Experience in insurance and/or Workers Compensation claims is preferred.
SOFTWARE: Proficient in Microsoft Outlook, Excel, PowerPoint and Word. Adept at accessing business data from the Internet when required.