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Claims Assistant

Salary: $17.11-$20.88 hourly / $2,975-$3,632 monthly / Range: 5026

DEFINITION: Under close supervision, reviews and adjusts routine claims filed by employees for workers' compensation benefits or by other parties for liability and damages; provides clerical support to Risk Analysts in claims processing; and performs related work as required.

DISTINGUISHING CHARACTERISTICS: The Claims Assistant is distinguished from the Risk Analyst in that incumbents in the Claims Assistant class learn laws and procedures associated with workers' compensation or civil liability and learn to make routine decisions on less complex cases, based on a defined set of guidelines. The Claims Assistant does not have final responsibility for cases, as does the Risk Analyst.

Less complex workers' compensation cases are defined as those involving claims for medical treatment only, or those claims that do not involve litigation, permanent disability, or temporary disability lasting longer than four weeks; less complex civil liability cases are defined as those that do not involve litigation, cases in which relatively small amounts of damages are being claimed, or cases that do not require extensive investigation.

EXAMPLES OF DUTIES:

1. Makes determinations regarding compensability or liability/damage potential on routine cases; authorizes treatment or initiates other activities on claims, such as contacting outside adjustors or investigators; sets financial reserves for cases; determines temporary disability rates; reviews injury reports to determine possibility for third party liability; corresponds with claimants, attorneys, and others; sets diary dates for periodic review of case files; and determines which case files can be closed by reviewing files or researching court records.
2. Authorizes payments and completes necessary claims in order to pay vendors and claimants within prescribed deadlines; communicates with departmental representatives, vendors, attorneys, and claimants to clarify facts, correct errors in paperwork, and check on employees' work status or status of unpaid bills; and reviews paperwork submitted by claimants for accuracy, completeness, and timeliness.

EMPLOYMENT STANDARDS:

1. Equivalent to graduation from high school and three years of increasingly responsible clerical experience, preferably in an insurance, medical, or legal setting. One year of college may be substituted for one year of experience; or,
2. a combination of training, education, and experience that is equivalent to the employment standard listed above and that provides the required knowledge and abilities.

Knowledge of: general office practices and procedures, including recordkeeping and standard office equipment; business arithmetic; proper English usage, including grammar and composition.

Ability to: read, understand, and follow complex and strict regulations; perform multiple tasks under strict deadlines; learn to use various computer software programs and computer peripherals; make arithmetical calculations; do detailed work; compose letters, memos, and other written material; establish and maintain working relationships with medical providers, attorneys, claimants, and departmental personnel; and deal with the concerns of angry or hostile people.

DESIRABLE QUALIFICATIONS: Knowledge of medical and insurance terminology; familiarity with IBM personal computer operations.



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