Claims Clerk, Sr. reviews insurance claim forms and supporting documents for completeness and accuracy and obtains missing information as necessary. Inputs claim information into system for processing. Being a Claims Clerk, Sr. verifies coverage eligibility. Calculates settlement amounts according to guidelines. Additionally, Claims Clerk, Sr. processes routine claim payments. Requires a high school diploma or equivalent. Typically reports to a supervisor. The Claims Clerk, Sr. works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Claims Clerk, Sr. typically requires 1-3 years of related experience. (Copyright 2024 Salary.com)
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Job link: https://ats4.atenterprise.powerschool.com/ats/job_board_form?op=view&JOB_ID=4600296437&COMPANY_ID=JA001160&redirect_qs=&redirect_qs=start_index=100&APPLICANT_TYPE_ID=00000002&COMPANY_ID=JA001160
Capital Region ESD 113 is committed to closing gaps, growing people, influencing change, and eradicating racism through our service to our region and state. BIPOC as well as culturally and linguistically diverse candidates are strongly encouraged to apply.
This position is 8 hours/day and 260 days/year. Benefits include Medical/Dental/Vision, Life/AD&D insurance, FSA/DCAP, LTD insurance, Retirement/DCP, EAP, Annual/Sick Leave and Holiday Pay.
Purpose Statement
The job of Claims Specialist is done for the purpose/s of evaluating eligibility of medical only claims and adjudicating workers' compensation claims in compliance with state RCW and WAC regulations; conveying information regarding medical claims and benefits; supporting loss control services in participating school districts; documenting actions; and providing program support and services consistent with internal practices and procedures.
This job is distinguished from similar jobs by the following characteristics: Per the essential functions and educational requirements listed below.
This job reports to Director - Risk Management or Claims Administrator
Essential Functions
Marginal Functions
Job Requirements: Minimum Qualifications
Skills, Knowledge and Abililities
SKILLS are required to perform single, technical tasks with a need to occasionally upgrade skills in order to meet changing job conditions. Specific skill based competencies required to satisfactorily perform the functions of the job include: operating standard office equipment; using pertinent software applications; planning and managing case load and special projects; performing standard mathematical calculations; and preparing and maintaining accurate records.
KNOWLEDGE is required to perform basic math, including calculations using fractions, percents, and/or ratios; read a variety of manuals, write documents following prescribed formats, and/or present information to others; and understand complex, multi-step written and oral instructions. Specific knowledge based competencies required to satisfactorily perform the functions of the job include: worker compensation programs; state workers' compensation regulations and laws; medical and legal terminology related to worker's compensation; industrial insurance laws, medical aid rules and fee schedule; and basic anatomy and physiology.
ABILITY is required to schedule a number of activities, meetings, and/or events; often gather, collate, and/or classify data; and consider a variety of factors when using equipment. Flexibility is required to work with others in a wide variety of circumstances; analyze data utilizing defined but different processes; and operate equipment using a variety of processes. Ability is also required to work with a diversity of individuals and/or groups; work with data of varied types and/or purposes; and utilize a variety of types of job-related equipment. Problem solving is required to analyze issues and create action plans. Problem solving with data frequently requires independent interpretation of guidelines; and problem solving with equipment is moderate to significant. Specific ability based competencies required to satisfactorily perform the functions of the job include: communicating with diverse groups; working with frequent interruptions; working with detailed information/data; maintaining confidentiality; establishing effective relationships; adapting to changing work priorities; and thinking critically and executing processes efficiently.
Responsibility
Responsibilities include: working under limited supervision using standardized practices and/or methods; leading, guiding, and/or coordinating others; tracking budget expenditures. Utilization of resources from other work units may be required to perform the job's functions. There is some opportunity to impact the organization’s services.
Work Environment
The usual and customary methods of performing the job's functions require the following physical demands: occasional lifting, carrying, pushing, and/or pulling, some stooping, kneeling, crouching, and/or crawling and significant fine finger dexterity. Generally the job requires 70% sitting, 20% walking, and 10% standing. This job is performed in a generally clean and healthy environment.
Experience: Job related experience with increasing levels of responsibilities is required.
Education (Minimum): High school diploma or equivalent
Equivalency: None specified
Required Testing
None specified
Certificates and Licenses
Valid driver’s license & insurance coverage as required by law
WA State Self Insurance Certification at the time of hire or enrollment in a comprehensive goal-orientated curriculum within 90 days; achieve certification within two years from hire date
Continuing Educ. / Training
Maintains Certificates and/or Licenses as required and/or needed
Clearances
Criminal Background Clearance
WA State Sexual Misconduct Disclosure Release
FLSA Status
Non Exempt
Job Type: Full-time
Pay: $31.87 - $38.73 per hour
Benefits:
Schedule:
Work setting:
Ability to Relocate:
Work Location: In person
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