Claims Administrative Specialist I – ZenCare UR Centralized Unit

at  Zenith Insurance Company

Zenith 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.

JOB SUMMARY

Under general supervision and following standard procedures, performs routine but varied medical administrative duties of moderate complexity in support of the claims function. Duties include intake of treatment requests for multi-state jurisdictions, IMR processing, reviewing medical reports and RFA’s for validity and processing and compiling medical reports for utilization review. The essential functions of this position include, but are not limited to, the following:

• Intake of treatment requests for multi-state jurisdictions, IMR processing, reviewing medical reports and RFA’s for validity and processing and compiling medical reports for utilization review.
• 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.
• 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.
• 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 REQUIREMENTS

• High School Diploma or equivalent required.
• Bachelor’s Degree or equivalent combination of training/experience preferred.
• 2+ years work-related experience.
• Prior claims administrative support experience preferred with preference given to experience gained in Workers’ Compensation industry required.
• 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 $42,382.90 to $52,978.62. 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.

• Intake of treatment requests for multi-state jurisdictions, IMR processing, reviewing medical reports and RFA’s for validity and processing and compiling medical reports for utilization review.
• 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.
• 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.
• 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