Claims Assistant

Position Summary

The Claims Assistant provides administrative and operational support to the Claims team, ensuring timely and accurate processing of claim-related documentation, regulatory notices, and correspondence. This role supports compliance across all jurisdictions in which the assigned book of business operates, and helps ensure efficient mail, fax, litigation, and communication workflows.

Key Responsibilities

Claims Administration & Regulatory Compliance

• Prepare and complete all jurisdictionally required benefit notices accurately and within applicable regulatory timeframes (e.g., same-day or within 24 hours of check issuance, as required by the governing jurisdiction).
• Complete all other assigned claim tasks within five (5) business days, or sooner as business needs dictate.
• Ensure benefit notices are completed in time to meet same-day mailing deadlines.
• Verify all documentation includes the language, forms, and attachments required by the applicable jurisdiction.
• Identify and use the appropriate delivery method for claim notices (e.g., mail or email, where permitted by the jurisdiction).

Documentation & Records Support

• Assist with processing and tracking documentation related to claim activities.
• Ensure completeness, accuracy, and timely routing of all required forms and supporting materials.

Mail, Fax & Communication Management

• Pick up, open, date-stamp, and process incoming mail daily.
• Index and route mail to the document management system the same day for assigned adjusters.
• Scan and distribute documents, including:
  • Medical, translation, copy, and expert invoices to the designated bill-review vendor
  • Med-legal reports to examiners, managers, and the R&C Manager
• Manage outgoing mail, including general and certified mail, within established daily deadlines.
• Identify and route undeliverable ("Not Found") mail to the designated escalation inbox the same day.
• Prepare printed documents for mailing, including assembling and applying postage.
• Maintain office equipment readiness (e.g., ensuring copiers are stocked with paper).
• Monitor the fax inbox on a regular schedule and distribute incoming documents to the appropriate adjusters.
• Respond to phone calls and emails by end of day; address after-hours communications promptly at the start of the next business day.
• Manage toll-free/general inquiry calls and direct callers to the appropriate personnel.

Litigation & Hearing Support

• Log all hearing notices (e.g., mediation, trial, lien conference) received via mail into the litigation calendar and litigation log.
• Assist with electronic filing and service processes, including:
  • Managing new file setups
  • Maintaining recurring diary entries in the claims system until claim closure
• Participate in litigation committee meetings as scheduled.
• Provide documentation to defense counsel with transmittal letters via the designated secure file-sharing platform.

Tracking, Reporting & Vendor Coordination

• Complete tracker forms for non-cashed checks within required timeframes.
• Document communication attempts and escalate issues to examiners and management as appropriate.
• Maintain and submit delay logs (including permanent disability delays, where applicable) to management on a regular schedule.
• Support daily task tracking and ensure timely completion of assigned work.
• Process subpoenas of records through the designated records-request platform.
• Coordinate with vendors and internal stakeholders for document handling and processing.

Team & Operational Support

• Provide phone coverage shared among Claims Assistants.
• Support managers with special projects as assigned.
• Collaborate with adjusters and team members to ensure workflow efficiency and alignment.
• Maintain strong organization and prioritization across high-volume, time-sensitive tasks.

Qualifications

• High school diploma required; Associate's or Bachelor's degree preferred.
• 1–3 years of administrative or claims support experience (insurance environment preferred).
• Knowledge of workers' compensation processes and regulatory requirements across multiple jurisdictions is a plus.
• Strong organizational skills and ability to manage jurisdiction-specific deadlines across a multi-state caseload.