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Assistant Claims WC

Sedgwick

This is a Full-time position in El Dorado Hills, CA posted May 26, 2020.

Location: El Dorado Hills, CA

JOB SUMMARY:

Assists claims examiners by providing clerical support.  Responsible for payment of all indemnity payments, processing and payment of all bills, performing all clerical tasks and supporting the supervisor to ensure team is meeting performance standards and procedures.

ESSENTIAL JOB RESPONSIBILITIES:

  • Payment of all indemnity payments and responsibility for ongoing payment as needed, along with creating required DWC notices.
  • Completing all clerical tasks assigned, such as file and serve documents to attorneys, doctors, employees and employers, bill objection letters, litigation referrals, scheduling doctor appointments, requesting records, etc.
  • Processing payment of in house bills timely
  • Fosters a teamwork attitude in the department to include maintaining good relationships with examiners and supervisor, initiative to learn workers comp and offering assistants when daily work has been completed.

OPS RACI RESPONSIBILITIES:

  • Investigations
  • Denials
  • Benefit Delivery
  • Penalties and E&O’s
  • Significant Claims Activities
  • Continuous Improvement

SUPERVISORY RESPONSIBILITIES:

SUPERVISION RECEIVED:

  • This position reports to the Unit Manager

SUPERVISION EXERCISED:

  • NA

POTENTIAL ADDITIONAL RESPONSIBILITIES:

  • Responsible for setting up new claims and creating files,
  • Setting up new claims within 1 day, preparing required letters and data integrity in claims system

QUALIFICATIONS:

EDUCATION:

  • BS / BA or Equivalent Work Experience

EXPERIENCE:

  • 1 year

SKILLS/ABILITIES:

  • Must be able to prioritize tasks according to strict timelines
  • Must be able to work alongside claims examiner as a partner as clerical support

KNOWLEDGE:

  • Computer experience – Typing at least 45 – 60 wpm, moderate understanding of Word and e-mail programs
  • Moderate customer services skills for phone, email and letter production

ROUTINE DECISIONS AND FORMAL POLICY SETTING:

Decisions routinely made include:

  • Reviewing and verifying ongoing need for continued indemnity payments with appropriate documentation within strict timeframes

Policy setting:

  • No formal responsibility;  Policies associated with the job’s purpose and essential responsibilities are set by others