Claims Assistant Resume Samples

Description :

1. Assists in the processing of veterans claims by utilizing knowledge of Veterans Service Center filing procedures.
2. Plans, coordinates, and develops claims folders in cooperation with other government entities, such as Board of Veterans Appeals.
3. Analyze requests received for permanent and temporary transfer of folders, identifying and forwarding misdirected mail to the appropriate offices.
4. Serve as a liaison between mid-level and senior level management to ensure effective distribution of cases.
5. Examine claims folders on a continuing basis to eliminate and reduce misfiled folders, sorting and pulling active mail in an effort to keep files up to date.
6. Receives, disseminates, and tracks claims for review.
7. Establishing effective relationships at all levels to promote professionalism.
8. Ensure compliance with regulatory and statutory, laws, and regulations.

Experience

2-5 Years

Level

Executive

Education

Business Administration

Description :

1. Support & interact with examiners, specialists, injured workers, employers, counsel, physicians and service providers.
2. Filed & served Stipulations, Settlements, medical reports, and letters to WCAB, attorneys and doctors.
3. Prepared file copies for Legal Referrals for defense attorneys.
4. Processed disability notices, lien objections, and medical correspondence letters.
5. Scheduled comprehensive medical appointments, interpreters, transportation, and mileage reimbursements.
6. Efficiently worked with staff nurses regarding medical status updates and recommendations.
7. Entered benefit compensation, service provider payments, and medical mileage payments in a timely manner.
8. Completed requests for subpoena of records, stop payments, check copies and re-issues.

Experience

7-10 Years

Level

Management

Education

AA In Liberal Arts

Description :

1. Examines a variety of claims to determine entitlement and appropriateness for payment of emergency room treatment, ambulance trips and non-VA hospital care as defined under the Millennium Health Care Act.
2. Develops claims under the Millennium Health Care Act; requesting information when required and presents to clinical liaison for final determination.
3. Ensures prompt payment of authorized ambulance, emergency room visits and emergent inpatient treatment as defined under the Millennium Health Care Act, in addition, emergency room visits and ambulance trips under fee basis guidelines.
4. Examines a variety of claims to determine entitlement and appropriateness for payment of authorized and unauthorized outpatient treatment; medications, and beneficiary travel for veterans.
5. Reviews, audits and processes claims/invoices (authorized and unauthorized) received from vendors and/or fee basis participants to insure information necessary for processing is present, contacts physicians, hospitals, pharmacies, veterans and their accredited representative to obtain supportive information for development of claims.
6. Downloads and processes claims that are received electronically under the Fee Payment Processing System (FPPS).
7. Extensive telephonic contacts with private sector physicians, veterans/beneficiaries and family members.

Experience

5-7 Years

Level

Consultant

Education

Master Of Science In Management

Description :

1. Assisting with workman's compensation claims for State of Illinois employees Sets up new claims in system and paper files, ensuring all documentation is recent and correct.
2. Prepares, schedules and processes benefit and medical payments on claim files as directed by the Claims Examiner.
3. Documents all work product and claim activity in the electronic claim file.
4. Prepares and prints letters, benefit notices and labels.
5. Provides clerical support, including filing, faxing, sorting, and alphabetizing.
6. May print and reconcile checks, as needed specific to branch office.
7. Communicates pertinent claim information to the client, legal counsel, medical and rehab providers and internal claims staff.
8. Answers phone calls, take messages and responds appropriately.

Experience

2-5 Years

Level

Executive

Education

Diploma

Description :

1. Assist Claims Examiners and Supervisors with the handling of Workers' Compensation (WC) claims.
2. In charge of writing and sending all settlement documents to the Workers' Compensation Appeals Board and Rehabilitation Unit for settlement.
3. Perform three-point contact to the insured, claimant and physician within twenty-four hours.
4. Claimant contact is done every thirty days on indemnity claims.
5. Physician contact is performed as needed to ensure timeliness of benefit payment.
6. Issue payment to venders for services rendered on the WC files.
7. Perform all aspects of setting up a claims file.

Experience

5-7 Years

Level

Executive

Education

Diploma

Description :

1. Prepared and organized files for new claims.
2. Assisted the Claims department staff in updating and documenting claim files.
3. Assisted in processing transactions (opening reserves, closing, checks).
4. Performed follow up on claim handling by insurance companies.
5. Processed stop payments and fax police reports.
6. Provided the claims manager support services and maintained unit's claim files.
7. Coordinated claims process activities, for auditing functions - Set up and entered new claims into claims management system.

Experience

5-7 Years

Level

Consultant

Education

Diploma

Description :

1. Provided information to vendors and patients on the status of their individual medical claims.
2. Provided claim status and respond to inquiries in a timely fashion.
3. Informed vendors and veterans of the Millennium Health Care Act and verify veteran eligibility status in the benefit program in regards to emergent care and non-emergent care.
4. Advised vendor of additional information needed by serving as a clinical liaison.
5. Provided payment information on paid claim status and advise of any discrepancy preventing completion.
6. Informed of appellate rights in regards to disputes for both vendors and patients.
7. Received and process mail for the scanning and uploading forms in the Fee Basis Claims System.
8. Assisted in the processing of filing all types of insurance claims for our customers.

Experience

2-5 Years

Level

Executive

Education

Business Administration

Description :

1. Appointed as the first line of contact when a General Liability Claim was presented.
2. Responsible for answering and documenting telephone calls from Claimants, Plaintiff Attorneys, and Claim Adjusters.
3. Assisted the Senior Claims Manager with setting up new claims in the data base.
4. Analyzed the facts, secured pending information, and determined the liability.
5. Scheduled weekly telephone conferences with our insurance adjuster's and defense attorney's for status of pending claims; authorized the denial or settlement of claims.
6. Maintained a great rapport with claimants, attorneys, and adjusters.
7. Attended Small Claim hearings on behalf of the company; defended the company and/or settled with plaintiff.
8. Ensured the Motor Vehicle Reports adhered to company policies for new drivers.

Experience

10+ Years

Level

Senior

Education

Business Management

Description :

1. Preparing letters and issuing total temporary disability benefit payments.
2. Prepared file and serve letters, and responded to subpoenas by contacting the applicant attorneys and defense attorneys representing the claim.
3. Made determinations to accept, delay, or deny claims based upon valid medical, factual, or statutory reasons.
4. Determined probable monetary value of cases and assigned appropriate reserves; and reviewed reserves regularly to ensure adequacy.
5. Ensured payment of benefits in accordance to California Labor Code, ACOEM Guidelines, Administrative Rules and Regulations, and departmental policies and procedures.
6. Tracked injured employees' progress on returning to work after absence.
7. Reported associated lost days and modified days to employee supervisor and claims administration.

Experience

5-7 Years

Level

Consultant

Education

Business Administration

Description :

1. Setup new Worker's Compensation claims by entering into database and creating hard file.
2. Scan paper documents to be stored as well as maintaining paper files.
3. Provide high level of customer service via telephone and email to clients and participants.
4. Send electronic files to the State Board of Insurance to insure reporting compliance.
5. Process payments for claim expenses including lawyer fees, medical bills, etc.
6. Act as receptionist for Worker's Compensation calls from participants and clients.
7. Created and maintained complex filing system for large volume of information.

Experience

5-7 Years

Level

Consultant

Education

Diploma

Description :

1. Screened, reviewed and identified potentially eligible foster youth to be processed for SSI & RSDI/Title II benefits in our City of New York, Administration for Children Services (ACS).
2. Uploaded/tracked required SSI & RSDI/Title II information and managing related data.
3. Served as the primary contact for all team and client correspondence.
4. Facilitated communication between key stakeholders.
5. Compiled documents, including the drafting of correspondence and training protocols.
6. Assisted in the monthly preparation and submission of performance reports.
7. Ensured the protection of confidential materials.
8. Maintained knowledge of ACS practices and policy changes related to SSI & RSDI/Title II benefits.

Experience

2-5 Years

Level

Executive

Education

Psychology

Description :

1. Created letters based off of the property, auto, and surety claims adjusters request.
2. Ran reports once the claims were filed to insure the claim was not a duplicate or insurance fraud.
3. When a vehicle was a total loss and the title came in, I would send the title to the yard so the vehicle could be sold.
4. Scanned documents into the systems to be attached at a later time.
5. Delivered mailed to other claims assistants.
6. Reviewed spreadsheets to make sure glass claims were closed correctly.
7. Assist in bill payment process, and data entry task and documentation production.

Experience

2-5 Years

Level

Executive

Education

Master's

Description :

1. Serve as the initial reviewers for compensation and pension claims.
2. Responsible for the care and maintenance of the claims folders, analyzing the claim, and determining if the disposition of the claims and control action have been appropriately identified.
3. Develop straightforward evidence in conjunction with claims, establish or update control action, and facilitate workflow between the team and other Veterans Service Centers (VSC).
4. Ensures that claims are processed so Veterans receive the benefits they have earned through their service.
5. Provided high quality customer service by determining the best approach for each individual customer.
6. Inputted all updates into databases while processing claims applications and associated paperwork.
7. Used personnel time to keep Veterans up to date with the most current information on all Benefits, and privileges offered under the body of the Federal law.

Experience

2-5 Years

Level

Executive

Education

Information Technology

Description :

1. Provides administrative and clerical support to the claimant representatives.
2. Responsible for the process and accuracy of SSA forms.
3. Responsible for a wide range of job dutiesfrom talking with customers on the telephone to copying, typing/keyboarding, and filing.
4. Performs vital data entry into the Case Management system as cases progressesthrough the disability process.
5. Document thoroughly and accurately the Notes database with any information related to the claim.
6. Sets the appropriate next action step for the disability claim.
7. Submits the disability formsto be forwarded to the claimants, Social Security, and Disability Determination Services.
8. Prepares and selects the correct letters to be forwarded with these forms.

Experience

2-5 Years

Level

Executive

Education

Pharmacy Technician

Description :

1. Under technical direction, works within significant limits and authority on new medical only claims.
2. Responsible for claims management of assigned cases within guidelines of published performance standards.
3. Issue medical payments according to set procedures and working with examiners with reserving.
4. Issue disability payments within given authority.
5. Input and monitor automatic disability schedule payments and cancellations.
6. Perform electronic investigation relating to background checks, other reported injuries and death records searches.
7. Perform other clerical duties as assigned such as filing, sorting, requesting of records, mailing of records.
8. Completing reimbursement requests either through a 3rd party or filing directly with the State.

Experience

10+ Years

Level

Senior

Education

Technical Certificate