Claims Assistant

Description This position provides clerical and customer service support for claims processing while ensuring compliance with deadlines and regulations set by the Texas Department of Insurance, Division of Workers' Compensation. It includes coordinating incoming and outgoing communications, handling claim documentation, assisting adjusters with administrative tasks, and maintaining accurate records. Essential Functions Required Responsibilities: Process faxes, Workers' Compensation emails, and Member portal documents to the appropriate claims. Completes activities in the claims management system assigned by adjusters, including phone calls, emails, correspondence, travel requests, medical reimbursements, and medical records requests. This may include gathering and emailing a large number of documents to medical providers and attorneys. Verifies and processes new claims, which may require direct communication with Members, providers, and claimants. Maintains office operations, including monitoring office and kitchen supply inventory and participating in training or cross‑training as needed. Answers and returns phone calls, providing accurate information and assistance to providers, claimants, and Members. Prepares and processes outgoing and incoming mail, including faxes, emails, and returned mail. Researches and resolves unprocessed documents and medical bills, which may involve contacting claimants, Members, and providers to establish claims or return materials within required timeframes. Documents and enters claim‑related data into the claim management system as provided by claimants, Members, attorneys, and providers. Performs tasks related to Electronic Data Interchange (EDI), including managing desktop queues, initiating manual EDI triggers, making corrections through the Verisk System, and collaborating with teams and vendors. Resolves tasks in the Mitchell Claim system and provider queues for medical bills, requiring detailed research, compliance tracking, and coordination with internal departments and providers for W9‑related issues. Monitors and maintains the Explanation of Benefits portal, assisting providers with claim bill status inquiries. The above responsibilities are intended to describe the general nature and level of work being performed by individuals assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required by the position. All employees may have other duties assigned at any time. Job Requirements Education, Work Experience, Certifications Required High School diploma or equivalent Years of Experience: 1 Area of Experience: Workers’ Compensation, Administrative Work Equivalent combinations of education and experience will be accepted Preferred None Essential Competencies and Skills Required Proficiency in MS Excel Proficiency in MS Word Proficiency in MS PowerPoint Proficiency in MS Outlook Proficiency in MS Teams Preferred Proficiency in Adobe Acrobat Pro Proficiency in MS SharePoint Experience with Guidewire To perform this job successfully, an individual must be able to perform each primary responsibility satisfactorily. The requirements listed above are representative of the knowledge, skill, and/ or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the primary responsibilities. Supplemental Information Work Leadership Requirements This position is not a people manager. This position does not have indirect reports. Travel Requirements None Physical Requirements Be able to withstand typical office work that includes periods of sitting, standing, typing, etc., indoors while potentially performing job tasks in close proximity to other people. In addition to typical office work, must be able to exert up to 10 pounds of force occasionally to move objects. Requires close visual acuity to perform an activity such as preparing and analyzing data and figures, viewing a computer screen, visual inspection, assembly of parts, or extensive reading. Ability to have a flexible work schedule to meet business needs and be at work on‑site during specified or core hours. Must be able to operate standard computer hardware. Additional Information Equal Opportunity: The Texas Municipal League Intergovernmental Risk Pool is an Equal Opportunity Employer and welcomes applications from all qualified applicants. We do not discriminate on the basis of race, color, religion, sex, national origin, age, marital status, medical condition, disability, or sexual orientation. Reasonable Accommodation: The Texas Municipal League Intergovernmental Risk Pool makes reasonable accommodations for the disabled. If you believe you require special arrangements to participate in the testing process, you must inform the People Resources Department in writing no later than the filing date. Applicants who request such accommodation must document their request with an explanation of the type and extent of accommodation required. TMLIRP requires all staff members to reside in Texas. If you are not currently located in Texas, you must be willing to relocate to Texas by your start date at your own expense (relocation assistance is not provided). When you join the Pool, you’re not just stepping into a role, you’re gaining a meaningful benefits package designed to help you thrive both personally and professionally. Benefits Medical Insurance – 100% employer-paid for employees, with subsidized coverage available for dependents Dental & Vision Insurance – 100% employer-paid comprehensive coverage for you and your family Flexible Spending Accounts (FSA) – for healthcare and dependent care expenses Health Savings Account (HSA) – additional support for medical expenses Texas Municipal Retirement System (TMRS) – with a generous 2:1 employer match 457(b) Deferred Compensation Plan – 6.2% employer contribution to support long-term financial planning Disability Insurance – 100% employer-paid short-term and long-term disability coverage Life and AD&D Insurance – 100% employer-paid coverage that provides added financial protection Paid Time Off – includes 9 holidays, vacation, sick leave, and personal holidays Education Assistance – up to $6,000 annually to support your continued learning and professional development #J-18808-Ljbffr Texas Municipal League Intergovernmental Risk Pool