Claims Administrative Specialist I

Zenith Insurance Company

  • Fresno, CA
  • $43,996-54,995 per year
  • Permanent
  • Full-time
  • 20 days ago
Description :Job PostingZenith is a team of Workers’ Compensation Specialists committed to helping businesses succeed by protecting against the financial and human consequences of workplace injuries, providing for the needs of injured employees and making the workplace safer. To distinguish ourselves as the desired provider of Workers’ Compensation Insurance, values such as collaboration, work-life balance, and integrity are placed at the center of all our operations. In addition, Zenith supports career advancement through a dedication to ongoing learning and development. An individual coming to Zenith will not only receive competitive compensation and a comprehensive benefits package, but continuous opportunities to grow as a professional.A Brief OverviewUnder 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 best practices within expected timeframes completing the following tasks.What you will do
  • 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 Qualifications
  • High School Diploma Or equivalent required
  • Bachelor’s Degree or equivalent combination of training/experience preferred
Experience Qualifications
  • 2+ years work-related experience prior Claims administrative support experience preferred with preference given to experience gained in Workers’ Compensation industry required
Skills and Abilities
  • 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
The expected salary range for this position is $43,996.29 - $54,995.36. Actual pay will be adjusted based on experience, geographic location, and other job-related factors as permitted by law. Qualifications may warrant placement in a different job level.Benefits
  • Medical, Dental and Vision Insurance
  • Flexible Spending Accounts
  • Paid Parental Leave
  • Life, AD&D and Disability Insurance
  • 401(k), Employee Share Purchase Plan (ESPP)
  • Education and Training Reimbursement
  • Paid Leave: 3 weeks/year Vacation, 2 weeks/year Sick Leave
  • 10 paid Company Holidays, 2 Personal Days, 2 Floating Holidays
  • Employee Assistance Program (EAP)
  • For more information, review details on the Benefits page of our Career Site:
Zenith typically posts jobs for a minimum of 8 to 14 calendar days. If you are interested in any of our open positions, we encourage you to submit your application promptly.Zenith Insurance Company is an equal opportunity employer and considers all qualified applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristic. In compliance with California law, we are committed to fair hiring practices. Pursuant to the California Fair Chance Act (AB 1008), we will consider qualified applicants with criminal histories in a manner consistent with the law. Additionally, in accordance with the Los Angeles Fair Chance Initiative for Hiring Ordinance, we will not inquire about an applicant’s criminal history until after a conditional offer of employment has been made.If you are a qualified individual with a disability or a disabled veteran and need assistance accessing our career center or applying for a position due to your disability, you are entitled to request an accommodation. To make a request, please contact a Human resources representative at Zenith Insurance Company.#LI-EF1
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Zenith Insurance Company