Claims Assistant

Requisition ID # 173517 

Job Category: Administrative / Clerical 

Job Level: Individual Contributor

Business Unit: Energy Delivery

Work Type: Onsite

Job Location: Oakland

Position Summary:
Job responsibilities may include, but are not limited to: Assist in any administrative or Workers’ Compensation (WC) claims activities which may be required in order to provide timely, accurate, professional services to our clients and comply with requirements under Workers’ Compensation Law. The claims assistants report directly to the Workers’ Compensation Supervisor (WCS). However, the claims assistants will work under the broad direction and guidance of the individual Workers’ Compensation Representative (WCR). The position requires solid management skills, effective communication skills (oral and written), interpersonal skills, conflict resolution skills, the ability to interact with others, including external and internal clients (venders, medical and legal professionals, etc.), knowledge of medical terminology and WC rules and regulations. The WCA must employ analysis skills, have a working knowledge of other leave types (FMLA, LTD, etc.), the ability to recognize HR overlap issues (FEHA, EEOC, Bargaining Unit issues, etc.). Must have strong organizational skills, the ability to prioritize, basic arithmetic, computation skills and must be able to make “judgment calls” as needed, when the WCR/WCS is unavailable to provide direction.

Job Responsibilities:
WC Claims Assistant – Intermediate (#50010935)
Performs diverse clerical or technical tasks requiring judgment and initiative.
Examples include preparing moderately complex forms in an established manner, composing routine correspondence, and answering technical inquiries and
scheduling appointments.
Overall responsibility is to assist assigned WCR in the management of workers’ compensation claims. Generally requires limited supervision. C/A should be able to recognize and handle issues within the C/A’s skill set, as agreed with supported WCRs. Typical duties and responsibilities include, but are not limited to:
•    Reviews and prioritize assigned work
•    Performs general data entry, as requested
•    Documents VOS (WC claims management system) as required
•    Performs all copy work as requested
•    Schedule medical appointments, as assigned
•    Process employee reimbursement requests
•    Maintains all documents and
correspondence in the claim files, as required per Quality Claims Management (QCM), requirements
•    Communicates with internal and external clients in a clear, concise manner to appropriately assist in the administration of benefits. [External clients include but are not limited to attorneys, medical professionals (including doctors), and vendors related to the administration of WC Claims.]
•    Request/subpoena records
•    Processes file and serves as assigned
•    Processes legal forms and documents as assigned
•    Makes travel arrangements as needed
•    Researches information when necessary
•    Develops the ability to manage the Helpline, responding to questions regarding WC benefits, answering basic questions, in lieu of transferring the call to the WCR or WCS for handling
•    Applies standard techniques, procedures, criteria to routine and limited scope assignments.
•    Typically receives minimal instructions on routine assignments, and general instructions on new assignments or projects.
•    Assignments are regularly reviewed.
•    Primary focus is working with peers within department and some internal and external clients.

Qualifications:
Minimum:
•    HS Diploma or Equivalent Required
•    BA – Desired
•    1 to 5 years Claims Assistant experience or equivalent preferred, sufficient to provide basic knowledge of WC requirements and processes.

Desired:
•    Must have knowledge of Microsoft Word and Excel
•    Must have working knowledge and skills to use computer terminal keyboard/computer
•    Telephone
•    Printer
•    Photocopy machine
•    Writing implements
•    Overall general office equipment (adding machine, fax machine, etc.)
•    Must have ability to learn software