Job: CLAIMS TRAINEE

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Jobing Description

The Claims Trainee is the first working professional level of claims handling. Under close supervision, the Claims Trainee will receive in-depth training of department objectives, and workers’ compensation laws to be able to administer basic claim benefits. The training will consist of learning PEIC’s First Report Program while handling simple medical only claims to handling complex medical only claims, involving non-litigated, minimal lost time, soft tissue type injuries, including strain/sprain injuries due to repetitive motion, and minor indemnity disability claims.

The Claims Trainee will ultimately be able to determine compensability, clear the EOR’s to review bills for payment, including EOR’s on closed claims. This position will be a back up to the FRU and CA ACD group. Claims handling activities will be performed in compliance with the rules, regulations and statutes of the WCAB and the State of California. The Claims Trainee must exhibit the ability to grasp concepts. Attention to detail, timeliness, and accuracy are key components of their responsibilities.

RESPONSIBILITIES:

* Provide customer service – answer telephones by the third ring and re-direct callers as necessary to properly respond to customer inquiries.
* Complete three-point contact to properly investigate assigned claims, evaluate coverage and determine compensability.
* Perform data entry to setup new claims, work diaries and create activity notes.
* Complete and prepare documentation for referrals to investigators and copy service subpoenas.
* Reserve claim file appropriately for anticipated expense, indemnity and medical costs.
* Negotiate outstanding liens on settled claims.
* Complete assigned work via diaries and work queues in a timely manner.
* Appropriately initiate QME and Voucher process for unrepresented claims.
* Perform other duties as requested by manager.

KEY ACCOUNTABILITIES: MEASUREMENT:

Accuracy The accuracy of data entry
Timeliness Meeting all established deadlines
Team Player Willingness to assist others when needed

Skills / Requirements

* 4-year degree required.
* Proficient with MS Office software and PC applications and systems.
* Ability to work both independently and collaboratively with all levels of staff.
* Strong written and verbal communication skills, attention to detail and deadline structures.