Claims Administrative Specialist I

Zenith Insurance Company•Los Angeles, CA

12d•$39,997 - $49,996

About The Position

Under direct supervision, the Claims Administrative Specialist I performs administrative duties of moderate technical complexity in support of the Claims function. The incumbent is expected to consistently apply best practices and complete work within expected timeframes to deliver a quality claim product. The role provides ongoing administrative support to Claims Examiners, Attorneys, and Nurses. Work includes processing payments and notices, supporting medical treatment and legal processes, coordinating appointments and meetings, maintaining claim records and agendas, responding to calls and requests, and completing diaries and follow-up tasks. The position also requires sound judgment, collaboration, responsiveness to direction and feedback, and a consistently professional demeanor.

Requirements

High school diploma or equivalent combination of training and experience.
At least 2 years of work-related experience.
Knowledge of Microsoft Office.
Advanced Microsoft Word and strong Excel skills.
Excellent spelling, punctuation, and grammar skills.
Ability to produce accurate final documents proficiently.
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.
Strong customer service skills.

Nice To Haves

Bachelor’s degree or equivalent combination of training and experience preferred.
Prior Claims administrative support experience preferred, with preference for experience in the Workers’ Compensation industry.

Responsibilities

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