Claims Assistant

Description Benefits Supplemental Questions
The City of Anaheim is seeking a dynamic individual for the position of Claims Assistant. This position is under minimal supervision to perform complex specialized clerical and technical work in the processing of claims in the area of workers compensation.
Essential Functions:
Set up claim files by assigning numbers, verifying information on injury form, setting amount of medical reserves required for injury (based upon past practice not predetermined amounts); reviews with Claims Examiner then enters into computer system.
Independently manage and process all "no lost time" claims (either no lost time or up to three (3) days lost time or medical treatment only); lost time claims, verify return to work or modified work status with treating physician and lifetime medical award claims.
Evaluate and authorize payment and issue checks to doctors, hospitals, pharmacies and all other vendors providing service on a claim; code all bills and tie back to a specific claim number; verify accuracy of bill to type of injury and determine reasonableness of charges; determine which bills are forwarded to a review service for further evaluation of unreasonable charges.
Advise employee injured on the job of their rights and benefits under Workers' Compensation Laws as to proper procedures to file a claim.
Review all physician reports and analyze medical diagnosis; determine if applicable to type of injury sustained or if it is a non-industrial injury; advise treating physician if payment is not approved.
Contact physician and employee to initiate early return to work dates at temporary light duty jobs; obtain physician release for light duty; contact departments for possible light duty assignments.
Monitor medical progress and set up exams with medical specialists for consultation, diagnostic tests and treatment; extend benefits as necessary; requests narrative reports of status.
Input, print and separate checks, mail originals and record dates and amounts into individual claim files; balance all payments and verify totals do not exceed reserve established for claim.
Each pay period, verify all industrial leave hours and dollars; verify employee went to doctor and/or was off on legitimate industrial accident (I.A.) time; if hours appear excessive, contact department for reason; independently determine what hours are appropriate and approve for payment.
Assist Claims Examiner with specific tasks related to claims administration.Perform related duties and responsibilities as required.
Experience assisting with highly complex worker's compensation claims that include clerical work, extensive record keeping, interpretation of policies and a high level of independence of action in performing duties.
Knowledge of advanced record keeping policies and procedures; modern office equipment and procedures; proper English usage; basic math and accounting practices; unemployment compensation, safety procedures, worker's compensation, medical terminology and/or general liability depending upon area of assignment.
Ability to operate a computer keyboard with accuracy and speed; use required software; work under stringent deadlines; work independently, with limited supervisory oversight; prioritize work; make effective and appropriate decisions; interpret and effectively communicate policies and procedures; read, understand and apply complex materials; compile data and prepare narrative and statistical reports; establish and accurately maintain extensive and complex record keeping systems; review and accurately interpret information; work in a high-volume multi-task environment with numerous interruptions; use proper grammar, spelling and punctuation; work accurately with figures; prepare clear and concise reports, letters and memos; communicate effectively both orally and in writing; deal effectively and professionally with adverse and difficult situations; take decisive action; establish and maintain effective working relationships with those contacted in the course of work.
Possession of Insurance Education Association certification is desirable.
Journey level experience as a Medical Only Adjuster, holding a State of California required designation as a Medical Only Adjuster is highly desirable.
Possession of an appropriate valid California Driver's License.
Supplemental Information:
Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received.
The deadline for the first review of applications is on Tuesday, December 6, 2016. Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date. Final date to submit applications will be Tuesday, January 3, 2017.
Candidates must be specific and complete in describing their qualifications for this position. Failure to state all pertinent information may lead to elimination from consideration. Stating "See Resume" is not an acceptable substitute for a complete application.
The successful candidate will be required to undergo a reference / background check (to include a conviction record) and pass a post-offer pre-employment medical examination (which will include a drug/alcohol screening).
The City of Anaheim utilizes E-Verify and new employees must provide documentation to establish both identity and work authorization.
Communications regarding your application and/or status will be sent to the email address listed on your application. Please check your email regularly throughout the recruitment process as you will not receive communication by any other method.

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