Claims Assistant

Gallagher•Corona, CA

10d

About The Position

Keenan, now part of Gallagher, is seeking a detail-oriented and organized Claims Assistant to support Claims Examiners in administering and managing workers' compensation claims. The role helps deliver service to injured workers, clients, medical providers, and internal teams while ensuring claims are handled accurately and efficiently. It involves maintaining claim files and records, processing payments and benefits, coordinating medical and legal processes, and communicating with claim stakeholders.

Requirements

High school diploma or GED.
At least 1 year of transferable work experience in an office environment.
Ability to pass any required licensing exams within three attempts.
Excellent written, verbal, and mathematical skills.
Working knowledge of current PC software such as Word and Excel.
Familiarity with medical terminology.
Ability to operate in a team environment and contribute to the office's overall effectiveness and success.
Ability to maintain strict confidence regarding information contained in assigned work.
Ability to interact professionally with branch personnel at all levels, clients, vendors, and other office visitors.

Nice To Haves

Licensed for all states in which claims are handled.
One year of relevant workers' compensation experience.

Responsibilities

Set up and maintain new claims files and enter claim data accurately.
Process indemnity payments, benefit calculations, and payment cycles.
Request and review wage statements and perform wage calculations.
Monitor claims to identify, prevent, and mitigate potential penalties.
Conduct 3-point contact to verify injury details, compensability, and work status.
Review and process Division of Workers' Compensation notices, letters, and forms.
Manage claim correspondence, including delay letters, statute letters, denial notices, and closing letters.
Calculate and process mileage reimbursements and related benefits.
Verify lost time, waiting periods, and return-to-work status.
Assist with modified duty and return-to-work programs.
Maintain diaries, claim notes, and electronic claim records.
Identify issues that may require escalation or conversion to indemnity claims.
Coordinate medical appointments and process Qualified Medical Evaluator referrals.
Process Independent Medical Review requests and utilization review referrals.
Prepare and serve legal documents, including Stipulations and Compromise & Release agreements.
Review mail, medical bills, and documentation daily to ensure timely processing and compliance.
Investigate questionable claim circumstances and escalate concerns when appropriate.
Collaborate with claims examiners, nurse case managers, medical providers, attorneys, and clients.
Maintain high levels of client and claimant satisfaction through responsive communication and service.