Claims Assistant - Workers' compensation

Claims Assistant (Workers' Compensation)

Optional Work from Home Dallas - Irving, TX 75038

Under close supervision, provides clerical, administrative, and data-entry support for the administration of workers' compensation claims. Supports Claims Examiners with claim setup, payment processing, correspondence, regulatory filings, and records maintenance.

Communicates regularly with claimants, medical providers, employers, investigators, attorneys, management, and TRISTAR staff. Completes assigned tasks in accordance with established procedures and Claims Examiner instructions and refers matters requiring claims decisions or authorization to the appropriate Claims Examiner or supervisor.

Duties and responsibilities include:

• Enters new claim information and establishes claim files in the claims management system.
• Assists with telephone communications concerning light-duty claims, as directed by Claims Examiners.
• Supports scheduled payment processing under the direction of a Claims Examiner.
• Processes special mailing requests in accordance with instructions and applicable deadlines.
• Prepares PLN notices and other state filings using information provided or approved by Claims Examiners.
• Assists with mail processing and check printing, as needed.
• Enters payments as directed by authorized claims staff.
• Receives, organizes, and distributes incoming mail and prepares outgoing correspondence and claim-related documents.
• Copies, scans, and organizes documents as directed.
• Answers and routes telephone calls, records messages accurately, and directs inquiries to the appropriate staff member.
• Prepares, generates, and runs reports from the claims management system, as requested.
• Maintains accurate records and promptly reports missing information or processing discrepancies.
• Performs other duties as assigned.

Equipment operated/used: Computer, telephone, 10-key calculator, fax machine, printers, and other standard office equipment.

Special equipment or clothing: Appropriate office attire.

Qualifications required:

Education/Experience: High school diploma or GED required. One (1) year of experience in the workers' compensation claims industry is preferred.

Knowledge, skills and abilities:

• Demonstrated keyboarding proficiency, with the ability to type at least 45 words per minute.
• Working knowledge of medical and legal terminology.
• Ability to alphabetize, collate, and organize documents accurately.
• Proficiency in Microsoft Word.
• Ability to follow written and verbal instructions from multiple staff members and seek clarification when priorities conflict.
• Strong attention to detail and a demonstrated ability to produce accurate work.
• Effective written and verbal communication skills.
• Professional and courteous telephone communication skills.
• Ability to prioritize multiple assignments and meet established deadlines.
• Ability to complete assigned tasks independently within established procedures and to collaborate effectively with the workgroup.
• Positive, service-oriented approach to supporting claims staff and resolving administrative matters.

Other qualifications:

• Certification and/or licensure as required by applicable state regulations.

Mental and physical requirements: [see separate attachment for a copy of checklist of mental and physical requirements]