Claims Assistant

Texas Municipal League Intergovernmental Risk Pool•Austin, TX

6d•Onsite

About The Position

This position provides clerical and customer service support for claims processing while ensuring compliance with deadlines and regulations set by the Texas Department of Insurance, Division of Workers' Compensation. It includes coordinating incoming and outgoing communications, handling claim documentation, assisting adjusters with administrative tasks, and maintaining accurate records.

Requirements

High School diploma or equivalent
1 Year of Experience in Workers’ Compensation or Administrative Work
Proficiency in MS Excel
Proficiency in MS Word
Proficiency in MS PowerPoint
Proficiency in MS Outlook
Proficiency in MS Teams

Nice To Haves

Proficiency in Adobe Acrobat Pro
Proficiency in MS SharePoint
Experience with Guidewire

Responsibilities

Process faxes, Workers' Compensation emails, and Member portal documents to the appropriate claims.
Completes activities in the claims management system assigned by adjusters, including phone calls, emails, correspondence, travel requests, medical reimbursements, and medical records requests. This may include gathering and emailing a large number of documents to medical providers and attorneys.
Verifies and processes new claims, which may require direct communication with Members, providers, and claimants.
Maintains office operations, including monitoring office and kitchen supply inventory and participating in training or cross-training as needed.
Answers and returns phone calls, providing accurate information and assistance to providers, claimants, and Members.
Prepares and processes outgoing and incoming mail, including faxes, emails, and returned mail.
Researches and resolves unprocessed documents and medical bills, which may involve contacting claimants, Members, and providers to establish claims or return materials within required timeframes.
Documents and enters claim-related data into the claim management system as provided by claimants, Members, attorneys, and providers.
Performs tasks related to Electronic Data Interchange (EDI), including managing desktop queues, initiating manual EDI triggers, making corrections through the Verisk System, and collaborating with teams and vendors.
Resolves tasks in the Mitchell Claim system and provider queues for medical bills, requiring detailed research, compliance tracking, and coordination with internal departments and providers for W9-related issues.
Monitors and maintains the Explanation of Benefits portal, assisting providers with claim bill status inquiries.