Job Description

Claim Assistant

Spooner Medical Administrators, Incorporated (SMAI) is a family owned and operated company that offers rewarding career opportunities for motivated individuals who are passionate about excellence and growth. Since 1997, SMAI’s proactive philosophy and best practices have set the standard in workers’ compensation by continuously improving the delivery of case management, utilization review and billing services to help facilitate a successful return to work for the injured worker.

The Claim Assistant is primarily responsible for supporting the Case Managers and Claim Analyst including correspondence preparation, mailing and telephonic communication with medical providers and injured workers. Process additional allowances, follow up on treatment requests and TENS supply needs.

Essential Functions

— Prepare case management introduction and closure packets for the injured workers.

— Initiate contact with injured workers and medical providers regarding treatment schedules.

— Obtain copies of medical records for diagnostic tests, consults, injections and surgeries.

— Send copies of positive diagnostic test results to the treating provider for their consideration of additional allowances.

— Correspond and follow-up with the BWC when additional allowances are filed.

— Perform telephonic follow-up with injured workers regarding TENS supply needs.

— Prepare correspondence for case managers and claim analysts.

— Process change of physician forms.

— Index documents as needed.

— Document all phone calls, emails and faxes sent to injured workers, employers and/or providers in computer system.

— Participate in continuous improvement activities and other assigned duties as assigned.

Supervision Received

Reports to the Claim Assistant Supervisor

Experience and Education Required

— High School diploma or equivalent

— General knowledge of the insurance industry with workers compensation exposure preferred

— Basic knowledge of medical terminology and medical forms

Additional Skills Needed

— Effective written and verbal communication

— Detail oriented

— Problem solving skills

— Strong organizational ability

— Basic computer literacy skills

Working Environment

The work environment characteristics described herein are representative of those an employee encounters while performing the essential functions of the job. While performing the duties of this job, the employee typically works in a normal office environment. The noise level in the work environment is usually quiet.

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