EMPLOYEE INSURANCE CLERK
DISTINGUISHING FEATURES OF THE CLASS: Under general direction of administrative and professional superiors, an employee in this class performs a variety of tasks associated with the administration of local self-insured Worker’s Compensation program, of the County Unemployment Insurance program, and the County employee health insurance program. Work includes reviewing claims to obtain, develop, and confirm relevant facts; recording all information and documentation of support or disqualify claims, and the maintenance of complex records necessary to the effective implementation of insurance-related employee benefit programs. Supervision may be exercised over one or two clerical employees.
TYPICAL WORK ACTIVITIES:
Receives and reviews claims for Worker’s Compensation from employees in order to determine eligibility for compensation or possible disqualifying conditions to be further examined and documented;
Receives, and insures compliance with, requests for information on matters relating to the employer’s participation in unemployment insurance programs and employee hospitalization programs;
Requests and receives necessary forms and documentation from claimant, claimant’s department head, medical personnel and other relevant sources of information for each insurance case or claim, including all forms required by law;
Prepares and maintains case files on all claims including all relevant and all required forms, information, and documentation to insure accuracy and completeness of facts and the timely processing of claims and payments;
Types all work required for each case, including forms and correspondence;
Prepares claims and, to an extent directed by an Administrator, processes payments to claimants, hospitals and physicians by reviewing claims and medical bills, applying appropriate laws, regulations and decisions to the facts established, using related rate charts and payroll data to make computations, dispersing work to appropriate county departments for approval and processing of checks, and verifying that checks are mailed promptly;
When required, assigns and supervises the daily activities of subordinate personnel;
Enrolls employees in health insurance program by advising on how to complete enrollment forms, typing out information and advising them on available coverage’s;
Cooperates with agents of the County, and with representatives of private carriers, in establishing and maintaining pertinent records;
Does related work, as required.
FULL PERFORMANCE KNOWLEDGES, SKILLS, ABILITIES, AND/OR PERSONAL CHARACTERISTICS: Good knowledge of Worker’s Compensation Laws, regulations, and rates of payment; good knowledge of the laws, and the application thereof pertaining to a municipal employer’s responsibilities with regard to unemployment insurance; good knowledge of rules, regulations, and procedures regarding eligibility for health changes in coverage, and waiting periods for late enrollers; good knowledge of the types of health insurance coverage, deductions, credits, and billing procedures; thorough knowledge of rules, regulations, and procedures regarding submission of major medical claims; working knowledge of medical terminology as it relates to prognosis and diagnosis as recorded in major medical claims; ability to communicate effectively in the office or over the telephone in explaining the provisions of the insurance program to employees and enrollees; ability to type at an acceptable rate of speed, with stipulated degree of accuracy; ability to maintain accurate records and files; ability to maintain confidentiality; integrity; physical condition commensurate with the demands of the job.
MINIMUM QUALIFICATIONS: Four years of full-time, paid experience in a general office clerical position, including at least 6 months experience processing insurance records or claims.
Competitive Classification