Salary: $17.11-$20.88 hourly / $2,975-$3,632 monthly / Range:
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
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
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
DESIRABLE QUALIFICATIONS: Knowledge of medical and insurance
terminology; familiarity with IBM personal computer operations.