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.

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Claims Administrative Specialist I

Zenith Insurance Company