Claims Adjuster Assistant

The New Mexico Self-Insurers' Fund is seeking a Claims Adjuster Assistant to perform a variety of complex clerical duties as needed to expedite processing and disposition of various claims filed against policies and programs of the New Mexico Self-Insurers' Fund and provide clerical support to Claims Adjusters related to claims, documents, and files. 

REPORTING STRUCTURE 

Works under the direct supervision of Claims Adjusters and general supervision of Risk Services Director. 

RESPONSIBILITIES 

Follows all procedures in the Claims Manual.

Performs routine setup and processing of all types of claims; initiates all records, computer entry of case information, receiving and logs first reports of accident for workers’ compensation claims; conducts log-in activities for civil rights cases and claims; verifies E-1 information; creates hard copy files and assures proper maintenance and accuracy of file information; prepares case files for outside adjusters, attorneys, etc.; prepares copied files for mailing; overnights mail materials as needed. 

Processes daily mail; sorts mail-in claims and assigns Claims Adjuster number and claim number to documents; distributes claims for review and adjudication; receives payments from accounts receivable, assures proper coding, recording, and deposits. 

Initiates telephone contact with members; verifies information on various documents received; assures proper disposition of files and documents to maintain case integrity; computer entry of narrative responses and notes from doctors, attorneys, etc. for review by Claims Adjuster; prepares correspondence as requested to claimants, attorneys, insurers, and insureds. 

Performs on-going document maintenance duties; monitors file status and activity; updates file records; follows established processes and procedures for the opening and closing of file records; may participate in the microfilming and archiving of records; enters narrative information into the system from officer and director notes as needed to assure quality care review. Meets with policyholders/claimants and corresponds via telephone regarding claims and payment status; responds to questions regarding claims process, policy descriptions and interpretations, payment process, eligible or covered services; requests information as needed to expedite claim adjudication. 

Performs other duties as assigned. 

QUALIFICATION CONSIDERATIONS 

Candidates should possess a high school diploma. 

Candidates should demonstrate ability to operate various office machines and equipment; communicate effectively in writing and orally; establish and maintain effective working relationships with professionals, executives, department heads, co-workers, and the public; work independently. 

Candidates should demonstrate ability to learn various office management systems related to alpha and numeric record keeping; interpersonal communication skills; telephone etiquette; personal computer operations and various program applications; and basic bookkeeping

COMPENSATION

Pay range will be commensurate with qualifications and experience. Compensation includes a comprehensive benefits package.