Claims Assistant

MRA-The Management Association
life insurance, tuition reimbursement

Oct 28, 2024
Company: Cities and Villages Mutual Insurance Company Location: Wauwatosa, WI Position: Claims Assistant WHY JOIN THE CVMIC TEAM: The ability to make a difference to internal and external customers! Great variety in what you do each day Flexibility with your schedule A supportive team environment Outstanding benefits that include: Company-paid retirement contribution into an SEP plan (after one year of employment), Company-paid health and life insurance monthly premiums, and tuition reimbursement for continuing education. View what employees say about working here! Under the direct supervision of the Worker's Compensation Claims Manager, this position is responsible for customer service and general clerical administrative duties related to worker's compensation claims administration. Essential Duties & Responsibilities Investigates and processes payments on medical-only claims in an accurate and timely manner; investigates and processes payments. Reviews first report of injury forms (WC-12) and follows up with claimant, insured, medical providers, or others in a timely manner to determine compensability. Enters worker's compensation claims information into Origami in an accurate and timely manner. Interviews, telephones, or corresponds with member representatives, member employees, supervisors, claimants, witnesses and medical personnel; reviews medical and hospital records in a timely manner to determine compensability while maintaining required confidentiality. Maintains and updates claim files with current diaries, file notes, and treatment plan in the claims system. Requests itemized medical bills and enters payments for Claims Specialists (checks and vouchers). Initiates a worker's compensation file for the Claims Specialists: Enters worker's compensation indemnity and medical claims information in an accurate and timely manner. Requests medical records when claim files are initiated. Handles or refers telephone, written, and email inquiries from members and others. Updates incentive information internally, as well as injured employees and members. Composes and edits routine correspondence. Compiles and distributes DWD pending reports. Contact for OSHA reports internally and to members. Reviews for accuracy. Qualifications High school diploma and the equivalent of one year of technical or business school training; and One - three (1 - 3) years related experience, or equivalent combination of education and experience. Knowledge, Skills & Abilities To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Knowledge of: Wisconsin Worker's Compensation Act, administrative code and case law. Claims handling practices and procedures; Office machines and proficient in the use of computers and computer software including Microsoft Word, Outlook, Excel, claims software and other business software. Ability to: Handle sensitive situations in a professional manner that reflects favorably upon the member and the Company. Effectively manage multiple assignments or tasks. Effectively work as a member of a team, coordinating and completing assignments in a timely manner. Communicate professionally, timely and effectively, both orally and in writing. Read and accurately interpret documents such as medical records and legal documents. Accurately and efficiently write routine reports and correspondence.