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Workers' Compensation Assistant Claims Examiner (Junior)

Posted 2 years ago in Insurance


Provide clerical and technical assistance to Senior Claims Examiners and administer Medical Only claims, ensuring timely processing of claims and payment of benefits, managing and directing medical treatment, and setting reserves.


Incumbent must have the skills, ability and judgment to perform the following essential job

duties and responsibilities with or without reasonable accommodation. Process new claims in compliance with client’s Service Agreement

Issue all indemnity payments and awards on time
Process all approved provider bills timely

Prepare objection letters to providers for medical bills; delayed, denied, lacking reports.

Answer questions over the phone from medical providers regarding bills

Contact treating physician for disability status

Contact employer for return to work status or availability of modified work.

Contact injured worker at initial set up

Send DWC notices timely

Issue SJDB Notices timely

Request Job Description from Employer

Handle Medical Only claim files

Calculate wage statements and adjust disability rates as required

Keep diary for all delay dates and indemnity payments

Documents file activity on computer

Update information on computer, i.e. address changes, etc.

Schedule appointments for AME, QME evaluations

Send appointment letters, issue TD/mileage, send medical file

Schedule interpreter for appointments, depositions, etc.

Request Employer’s Report, DWC-1, Doctor’s First Report if needed

Verify mileage and dates of treatment for reimbursement to claimant

Subpoena records

File and serve documents on attorneys, WCAB, doctors

Serve PTP’s with medical file and Duties of Treating Physician (9785)

Request PD ratings from DEU

Draft Stipulated Awards and C&R’s

Submit C&R, Stipulated Awards to WCAB for approval with documentation

Process checks – stop payment, cancellations, void, journal payments

Handle telephone calls for examiner as needed

Complete penalty calculations and prepare penalty worksheets

Complete MPN,HCO and/or EDI coding

Complete referrals to investigators

Complete preparation of documents for overnight delivery

Work collaboratively with Senior Claims Examiners, Nurse Case Managers and other

Assistant Claims Examiners

Contact with clients, injured workers, attorneys, doctors, vendors and other parties

Provide updates of claims status to Senior Claims Examiner's and management


The requirements listed below are representative of the knowledge, skill, and/or ability required.

Knowledge of workers’ compensation laws, policies and procedures

Verbal and written communication skills

Mathematical calculating skills

Computer processing skills

Ability to operate general office equipment

Ability to work in a paperless environment

Working knowledge or related information systems, including


Legal Solutions

Microsoft Office (Word and Outlook)

About Essential Staffing, Inc.:

Welcome to Essential Staffing, where we are profoundly dedicated to recruiting and staffing. Our core values of commitment and integrity drive our intense desire to obtain the best results for our clients, employees, and candidates.
Commitment. Dedication to a long-term course of action. We are committed to acting in the best interests of our clients, candidates, and employees.
Integrity. The quality or state of being of honest and sincere. In our relationships with clients, employees and candidates, we value honesty, fairness, and respect
Results. The consequence or consequences desired. We deliver the best results by doing the basics of our business superbly well.

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