Claims Assistant

Gallagher•Torrance, CA

14d•Remote

About The Position

Keenan is a leading insurance brokerage and consulting firm serving hospitals, public agencies, and California school districts. Specializing in employee benefits, workers' compensation, loss control, financial services, and property & liability. Keenan is committed to delivering innovative solutions that protect and empower the communities we serve. As part of Gallagher, a global leader in insurance, risk management, and consulting, you’ll be joining a team that’s passionate about helping individuals and organizations thrive. The Claims Assistant is responsible for assisting Examiners in every aspect of claims administration. They will identify, prevent and mitigate potential penalties as well as deliver 3-point contact. This is a remote position located in California.

Requirements

Required: High school diploma or GED and a minimum of 1 year transferrable work experience within an office environment.
Ability to pass any required licensing exams within three attempts.
Excellent written, verbal and mathematic skills.
Working knowledge of current PC software such as Word and Excel.
Familiar with medical terminology.

Nice To Haves

Licensed for all states in which claims are being handled.
One year relevant Worker's Compensation experience.
Ability to operate in a team environment with the expectation of enhancing and contributing to the offices overall effectiveness and success.
Able to maintain strict confidence regarding information contained in assigned work.
Ability to professionally interact with all levels of branch personnel, as well as, clients, vendors and all other office visitors.

Responsibilities

Input data entry on all new claims.
Provide indemnity payments and cycles.
Request wage statements and wage statement calculations.
Identify, prevent and mitigate potential penalties.
Deliver 3-point contact (MO &/or Indemnity files) to verify the mechanics of the injury, compensability and discharge.
Review all DWC letters (initial notices).
Input form letters (30 day closing letters when appropriate).
Calculate and pay mileage and benefits.
Verify lost time and waiting periods.
Review and manage modified duty.
Perform maintenance of current diary.
Input basic notes relating to claim, status and treatment.
Identify issues requiring conversion to Indemnity to include supporting documentation.
Refer all x-rays and diagnostic services to PRIME for utilization review.
Process medical bills daily to avoid penalty and interest.
Investigate all questionable claim circumstances and refer to the examiner when needed.
Maintain 100% closing ratio.
Return phone calls within 24 hours.
Review mail/bills daily – paperless system.
Correct error report daily.
Maintain client/claimant satisfaction.
Perform indemnity payments and cycles.
Request wage statement and wage statement calculations.
Input all DWC (Division of workers’ compensation) letters (notice, including denials).
Process QME (Qualified medical evaluator) to receipt of report.
Type Stipulations, mail to employee and WCAB (Worker’s compensation appeals board).
Type Compromise & Release and mail to the employee and WCAB.
Schedule appropriate medical appointments, calculate mileage, and send appointment letters.
File and serve appropriate documents.
Complete investigation and copy service request forms.
Refer all PRIME deletions to office designee only.
Complete IMR (Independent Medical Review) and process in a timely and accurate manner.
Maintain and update Work Status tab.
Input statute letters, delay letters, or any other required initial letter.
Interaction with nurse on case management regarding return-to-work status.
Other duties as assigned.

Benefits

Medical/dental/vision plans, which start from day one!
Life and accident insurance
401(K) and Roth options
Tax-advantaged accounts (HSA, FSA)
Educational expense reimbursement
Paid parental leave
Digital mental health services (Talkspace)
Flexible work hours (availability varies by office and job function)
Training programs
Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
Charitable matching gift program