Claims Administrative Specialist I

About the position Zenith is a team of Workers' Compensation Specialists committed to helping businesses succeed by protecting against the financial and human consequences of workplace injuries, providing for the needs of injured employees and making the workplace safer. To distinguish ourselves as the desired provider of Workers' Compensation Insurance, values such as collaboration, work-life balance, and integrity are placed at the center of all our operations. In addition, Zenith supports career advancement through a dedication to ongoing learning and development. An individual coming to Zenith will not only receive competitive compensation and a comprehensive benefits package, but continuous opportunities to grow as a professional. A Brief Overview Under direct supervision, the Claims Admin Specialist I performs administrative duties of moderate technical complexity in support of the Claims function. Incumbent must achieve a quality claim product on an ongoing basis by consistently applying best practices within expected timeframes completing the following tasks.

Responsibilities

• Issue timely and accurate allocated payments paying specific attention to timeframes and due dates.
• Calculate and issue Temporary disability payments, wage loss payments, and permanent disability payments within specified timeframes.
• Send correct DWC notices in compliance with expected timeframes.
• Review and label Documentum.
• Process and identify medical treatment requests through Zencare and complete follow up requests daily.
• Complete peer review packets by uploading medical records through Zencare to ensure that treatment decisions can be made timely.
• Schedule medical appointments, transportation and interpreters for injured workers and send necessary paperwork to all parties ahead of time.
• Review for accuracy, Examiner, Nurse or Attorney assignments prior to completion.
• File legal documents for attorneys through the EAMS website and ensure quality assurance of these documents.
• Assist nurses during the weaning process by sending out correct notices and completing the necessary paperwork.
• Set up meetings for Examiners, Attorneys and nurses when needed. This could include medical director staffing.
• Manage and update the Claims, Medical Legal weekly staffing agenda.
• Answer phone calls for Examiners and respond to requests from injured workers, Employers and brokers timely.
• Provide ongoing administrative support to Examiners, Attorneys and Nurses by completing work status calls, processing & formatting correspondence, and completing all paperwork and follow up phone calls timely.
• Complete all diaries within their specified time frames.
• Apply principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions.
• Work productively and harmoniously with others on a consistent basis.
• Respond positively to direction and feedback on performance.
• Consistently maintain professional and appropriate demeanor.
• Perform other duties/projects as assigned.

Requirements

• High School Diploma Or equivalent combination of training/experience required
• 2+ years work-related experience. Prior Claims administrative support experience preferred with preference given to experience gained in Workers' Compensation industry required
• Knowledge of Microsoft Office.
• Advanced Word and strong Excel software skills.
• Excellent spelling, punctuation and grammar skills required.
• Demonstrated ability to proficiently produce accurate final documents.
• Strong task management skills.
• High attention to detail.
• Strong organizational skills.
• Ability to manage time effectively and meet deadlines.
• Strong verbal and written communication skills.
• Strong math skills required.
• Strong customer service skills.

Nice-to-haves

• Bachelor's Degree or equivalent combination of training/experience preferred
• Prior Claims administrative support experience preferred with preference given to experience gained in Workers' Compensation industry

Benefits

• Medical, Dental and Vision Insurance
• Flexible Spending Accounts
• Paid Parental Leave
• Life, AD&D and Disability Insurance
• 401(k), Employee Share Purchase Plan (ESPP)
• Education and Training Reimbursement
• Paid Leave: 3 weeks/year Vacation, 2 weeks/year Sick Leave
• 10 paid Company Holidays, 2 Personal Days, 2 Floating Holidays
• Employee Assistance Program (EAP)

Apply tot his job Apply To this Job