Claims Assistant

Position Summary

The Claims Assistant provides administrative and operational support to the Claims team, ensuring timely and accurate processing of claim-related documentation, regulatory notices, and correspondence. This role is critical in maintaining compliance with jurisdictional requirements, supporting litigation processes, and ensuring efficient mail, fax, and communication workflows.

Key Responsibilities

Claims Administration & Regulatory Compliance

• Prepare and complete all DWC notices accurately within regulatory timeframes (same day or within 24 hours of check issuance).
• Complete all other assigned claim tasks within five (5) days or sooner as business needs dictate.
• Ensure benefit notices are completed by 12:00 PM to meet same-day mailing requirements.
• Verify all documentation includes appropriate jurisdictional language and attachments.
• Identify and utilize the appropriate delivery method for claim notices (e.g., email delivery where permitted).

Accommodation & Documentation Support

• Assist with processing and tracking documentation related to claim activities.
• Ensure completeness, accuracy, and timely routing of all required forms and supporting materials.

Mail and Document Management

• Pick up, open, date stamp, and process incoming mail daily (by 1:00 PM).
• Index and route all mail to Laserfiche the same day for assigned adjusters.
• Scan and distribute documents including:
  • Medical, translation, copy, and expert invoices (to CorVel for processing)
  • Med-legal reports (to examiners, managers, and R&C Manager)
• Manage outgoing mail:
  • General outgoing mail by 3:00 PM
  • Certified mail by 2:00 PM
• Identify and route “Not Found” mail to designated escalation inbox the same day.
• Prepare printed documents for mailing, including assembling and applying postage.
• Maintain office equipment readiness (e.g., ensuring copiers are stocked with paper).

Fax and Communication Management

• Monitor fax inbox every two hours and distribute to appropriate adjusters.
• Ensure adjusters receive timely notification of incoming documents.
• Respond to all phone calls and emails by end of day; address after-hours communications within three (3) hours of the next business day.
• Manage toll-free calls efficiently and direct inquiries to appropriate personnel.

Litigation and Hearing Support

• Log all hearing notices (MSC, Trial, Lien, etc.) received via mail into the litigation calendar and litigation log.
• Assist with File & Serve (F&S) processes:
  • Manage new file setups
  • Maintain recurring diary entries (every 30–45 days) in Guidewire until claim closure
• Participate in weekly litigation committee meetings.
• Provide documentation to defense counsel via ShareFile with transmittal letters.

Tracking, Reporting & Logs

• Complete tracker forms for non-cashed checks within required timeframes.
• Document communication attempts and escalate issues to examiners and management as appropriate.
• Maintain and submit delay logs (including PD delays) to management weekly.
• Support daily task tracking through the CA Log and ensure timely completion of assigned work.

Subpoena and Vendor Coordination

• Process subpoenas of records through Macro Pro.
• Coordinate with vendors and internal stakeholders for document handling and processing.

Team & Operational Support

• Provide phone coverage shared among Claims Assistants.
• Support managers with special projects as assigned.
• Collaborate with adjusters and team members to ensure workflow efficiency and alignment.
• Maintain strong organization and prioritization across high-volume, time-sensitive tasks.

Schedule & Workflow Expectations

• Benefit notices completed by 12:00 PM daily
• Mail pickup at 1:00 PM; outgoing mail completed by 3:00 PM
• Certified mail processed by 2:00 PM
• Fax inbox monitored every two hours
• Daily prioritization aligns with regulatory and business deadlines

Qualifications

• High school diploma required; Associate’s or Bachelor’s degree preferred
• 1–3 years of administrative or claims support experience (insurance environment preferred)
• Knowledge of workers’ compensation processes and regulatory requirements is a plus