Claims Administrative Specialist I

Zenith Insurance Company Fresno , CA 93707

Posted 3 months ago

Zenith is currently recruiting for a career-minded claims administrative professional. This role incorporates in-depth training in claims administration, opportunities to develop both administrative and technical skills, and the potential to grow and advance within a technical claims career in the future.

Under moderate supervision performs administrative duties of moderate technical complexity in support of the claims function. Incumbent must achieve a quality claim product on an ongoing basis by consistently applying Zenith and Chernow & Lieb Best Practices within expected timeframes completing the following tasks.

The essential functions of this position include, but are not limited to, the following:

  • Issue timely and accurate allocated payments paying specific attention to timeframes and due dates.

  • Calculate and issue Temporary disability payments, wage loss payments, and permanent disability payments within specified timeframes. Send correct DWC notices in compliance with expected timeframes.

  • Review and label Documentum.

  • Process and identify medical treatment requests through Zencare and complete follow up requests daily.

  • Complete peer review packets by uploading medical records through Zencare to ensure that treatment decisions can be made timely.

  • Schedule medical appointments, transportation and interpreters for injured workers and send necessary paperwork to all parties ahead of time.

  • Review for accuracy, Examiner, Nurse or Attorney assignments prior to completion

  • File legal documents for attorneys through the EAMS website and ensure quality assurance of these documents.

  • Assist nurses during the weaning process by sending out correct notices and completing the necessary paperwork.

  • Set up meetings for Examiners, Attorneys and nurses when needed. This could include medical director staffing.

  • Manage and update the Claims, Medical Legal weekly staffing agenda.

  • Answer phone calls for Examiners and respond to requests from injured workers, Employers and brokers timely.

  • Provide ongoing administrative support to Examiners. Attorneys and Nurses by completing work status calls, processing & formatting correspondence, and completing all paperwork and follow up phone calls timely.

  • Additionally, it is expected that you will perform any other specially assigned duties/tasks as they arise and complete all diaries within their specified time frames

  • Applies principles of logical thinking to define problems, collect data, establish facts, and draw valid conclusions.

  • Work productively and harmoniously with others on a consistent basis.

  • Respond positively to direction and feedback on performance.

  • Consistently maintain professional and appropriate demeanor.

  • Perform other duties/projects as assigned.

Education, Skills and Experience Requirements

  • High school diploma or equivalent required.

  • 2 years work-related experience required.

  • Prior claims administrative support experience preferred with preference given to experience gained in Workers' Compensation industry.

  • Knowledge of Microsoft Office required - possessing advanced Word and Excel software skills.

  • Excellent spelling, punctuation and grammar skills required. Work experience demonstrating ability to proficiently produce accurate final documents.

  • Strong verbal and written communication skills.

  • Strong math skills required.

  • Good organizational skills.

  • Qualifications may warrant placement in a different job level*

The above statements are intended to describe the general nature and level of work performed. They are not intended to be an exhaustive or exclusive list of the required responsibilities, duties and skills. Management retains the discretion to add to or change the duties and requirements of this position at any time as needs dictate.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Administrative Specialist

Department Of Veterans Affairs

Posted 3 weeks ago

VIEW JOBS 8/24/2021 12:00:00 AM 2021-11-22T00:00 * Videos Videos * Duties Help Duties Summary The incumbent serves as the Housekeeping Training Specialist for the Environmental Management Service (EMS) at the VA Central California Healthcare System. Learn more about this agency Responsibilities The primary responsibility of the incumbent is the development and implementation of the ongoing training programs for employees within the Housekeeping section of EMS as well as staff within the Textile Care Section and Interior Design Section that have functions/tasks related to the Housekeeping standard operation procedures manual, which includes training in chemical usage, competency development for specialty areas such as the Operating Suites, IV Preparation Room, Same Day Procedure, Nuclear Medicine, Hematology and Oncology, and the Special Procedures Lab. The incumbent assumes collateral assignments as appropriate. Promotion Potential: The selectee may be promoted to the full performance level without further competition when all regulatory, qualification, and performance requirements are met. Selection at a lower grade level does not guarantee promotion to the full performance level. Work Schedule: Monday to Friday; 8:00am to 4:30pm Telework: N/A Virtual: This is not a virtual position. Position Description/PD#: Administrative Specialist/PD023430 Relocation/Recruitment Incentives: N/A Permanent Change of Station (PCS): N/A PCS Appraised Value Offer (AVO): N/A Financial Disclosure Report: Not required Travel Required Not required Supervisory status No Promotion Potential 9 * Job family (Series) 0301 Miscellaneous Administration And Program Similar jobs * Computer Occupations, All Other * Development Specialists * Specialists, Development * Specialists, Training * Training And Development Specialists * Training Specialists * Requirements Help Requirements Conditions of Employment * You must be a U.S. Citizen to apply for this job * Designated and/or random drug testing may be required * Selective Service Registration is required for males born after 12/31/1959 * You may be required to serve a probationary period * Subject to background/security investigation * Selected applicants will be required to complete an online onboarding process Qualifications To qualify for this position, applicants must meet all requirements by the closing date of this announcement, 09/06/2021. Time-In-Grade Requirement: Applicants who are current Federal employees and have held a GS grade any time in the past 52 weeks must also meet time-in-grade requirements by the closing date of this announcement. For a GS-7 position you must have served 52 weeks at the GS-5 or higher. For a GS-9 position you must have served 52 weeks at the GS-7 or higher. The grade may have been in any occupation, but must have been held in the Federal service. An SF-50 that shows your time-in-grade eligibility must be submitted with your application materials. If the most recent SF-50 has an effective date within the past year, it may not clearly demonstrate you possess one-year time-in-grade, as required by the announcement. In this instance, you must provide an additional SF-50 that clearly demonstrates one-year time-in-grade. Note: Time-In-Grade requirements also apply to former Federal employees applying for reinstatement as well as current employees applying for Veterans Employment Opportunities Act of 1998 (VEOA) appointment. You may qualify based on your experience and/or education as described below: GS-7 * GS-7 SPECIALIZED EXPERIENCE: Must have one (1) full year of specialized experience equivalent to at least the next lower grade (GS-5) in the Federal Service that equipped you with the particular knowledge, skills, and abilities to perform successfully the duties of the position, and that is in or related to the work of the position to be filled. Specialized experience includes, but is not limited to: Coordination and management of various programs; experience in Teaching Others-Helps others learn through formal or informal methods; identifies training needs; provides constructive feedback; coaches others on how to perform tasks; acts as a mentor; Audit Reporting-Knowledge of the principles, practices, and techniques used to report audit findings (criteria, condition, cause, effect, and recommendation); Compliance-Knowledge of procedures for assessing, evaluating, and monitoring programs or projects for compliance with Federal laws, regulations, and guidance; Organizational Performance Analysis-Knowledge of the methods, techniques, and tools used to analyze program, organizational, and mission performance; Planning and Evaluating-Determines objectives and strategies; coordinates with other parts of the organization to accomplish goals; monitors and evaluates the progress and outcomes of operational plans; anticipates potential threats or opportunities. OR * GS-7 EDUCATION: Must have successfully completed 1 full year of graduate level education. Such education must demonstrate the knowledge, skills, and abilities necessary to do the work and be directly related to the duties of this position. TRANSCRIPTS REQUIRED - OR -Must have completed a 4-year course of study leading to a bachelor's degree and have superior academic achievement (S.A.A). S.A.A. must have been gained in a curriculum that is qualifying for the position to be filled and demonstrates the knowledge, skills, and abilities necessary to do the work and be directly related to the duties of this position. TRANSCRIPTS REQUIREDS.A.A. is based on (1) class standing, (2) grade-point average, or (3) honor society membership.1. Class standing -- Applicants must be in the upper third of the graduating class in the college, university, or major subdivision, such as the College of Liberal Arts or the School of Business Administration, based on completed courses.2. Grade-point average (G.P.A.)-- Applicants must have a grade-point average of: a. 3.0 or higher out of a possible 4.0 ("B" or better) as recorded on their official transcript, or as computed based on 4 years of education, or as computed based on courses completed during the final 2 years of the curriculum; orb. 3.5 or higher out of a possible 4.0 ("B+" or better) based on the average of the required courses completed in the major field or the required courses in the major field completed during the final 2 years of the curriculum.3. Election to membership in a national scholastic honor society * OR * GS-7 COMBINING EDUCATION AND EXPERIENCE: Must possess a combination of specialized experience and graduate education as described above. (TRANSCRIPTS REQUIRED) GS-9 * Specialized Experience: You must have one year of specialized experience equivalent to at least the next lower grade GS-07 in the normal line of progression for the occupation in the organization. Examples of specialized experience would typically include, but are not limited to: Skill in maintaining effective interpersonal relationships and negotiating solutions with supervisory, professional and non-professional staff, personnel and other services, staff in other VA Knowledge of computer systems and technical aspects of the hardware and software for output/input and analyses of data; Advanced computer skills (Microsoft Word, PowerPoint, Excel, Access); Familiarity with VHA Computer Programs (VISTA); Comprehension of EMS-related reports (MA-BPR, Textile Care, ATP); Knowledge of the TMS training program and the ability to organize materials, training documentation and records for the section; Knowledge of the TMS program to update employee training files and train key personnel in the use of the program; Knowledge of training and educational concepts in order to instruct all levels of employees, students, volunteers, CWT's, and EMS employees; Ability to adjust education materials and presentations to the level of the learner in order to maximize the learning process; Knowledge of a wide range of office automation skills and the use of several different software programs to enhance training programs. OR, * Education: Applicants may substitute education for the required experience. To qualify based on education for this grade level you must have a master's or equivalent graduate degree, or 2 full years of progressively higher-level graduate education leading to such a degree or an LL.B. or J.D., that is related to the work of this position as a substitute for the required experience. NOTE: TRANSCRIPTS MUST BE SUBMITTED FOR VERIFICATION. * OR, * Combination: Applicants may also combine education and experience to qualify at this level. You must have an combination of specialized experience and education beyond that required for the GS-07 level (The applicant's first year of graduate study is not qualifying for GS-9). NOTE: TRANSCRIPTS MUST BE SUBMITTED FOR VERIFICATION. You will be rated on the following Competencies for this position: You will be rated on the following Competencies for this position: * Audit Reporting * Compliance * Organizational Performance Analysis * Planning and Evaluating * Teaching Others Experience refers to paid and unpaid experience, including volunteer work done through National Service programs (e.g., Peace Corps, AmeriCorps) and other organizations (e.g., professional; philanthropic; religions; spiritual; community; student; social). Volunteer work helps build critical competencies, knowledge, and skills and can provide valuable training and experience that translates directly to paid employment. You will receive credit for all qualifying experience, including volunteer experience. Note: A full year of work is considered to be 35-40 hours of work per week. Part-time experience will be credited on the basis of time actually spent in appropriate activities. Applicants wishing to receive credit for such experience must indicate clearly the nature of their duties and responsibilities in each position and the number of hours a week spent in such employment. Education Physical Requirements: The work is a mixture of sedentary and physically demanding tasks. There will be walking; standing; bending; lifting of items up to 40 pounds, including training paperwork, manuals, and all equipment used in EMS. Incumbent may be susceptible to eyestrain from working long hours on the computer. For more information on these qualification standards, please visit the United States Office of Personnel Management's website at https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/. A transcript must be submitted with your application if you are basing all or part of your qualifications on education. Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: http://www.ed.gov/about/offices/list/ous/international/usnei/us/edlite-visitus-forrecog.html. Department Of Veterans Affairs Fresno CA

Claims Administrative Specialist I

Zenith Insurance Company