PO Box J Prague Oklahoma 74864 405

PO Box J Prague Oklahoma 74864 405.567.2611 Fax 405. 567.3307

www.agrip.org

2222 W. Main (Highway 62)

Job Descriptions for Claims Staff

As of January 2006

On January 04, 2006 Elizabeth Miller of County Risk Sharing Authority (Ohio) requested information on job descriptions for claims manager, adjusters, and administrative staff job descriptions. This document contains job description information for claims assistants and clerical positions.

Responses

1.  Janice Shirk, RN, Claims & Medical Manager, Pennsylvania Counties Risk Pool (PCoRP) Page 1

2.  Lynnette L. McHenry, Assoc. General Counsel & Claims Manager, Page 3

Idaho Counties Risk Management Program (ICRMP)

Janice Shirk provided the following information:

Job Description: Claims Administrative Assistant

The Position: The Claims Administrative Assistant is employed by CCAP to provide claims reporting services for the association’s insurance programs.

The Claims Administrative Assistant is part of the team of the CCAP Insurance Programs Office, performs most work with normal supervision and oversight, and reports to the Claims and Medical Manager for general direction and work evaluation.

Job responsibilities include setting up, refining and monitoring, in conjunction with

the Claims and Medical Manager, the check processing and financial components of the STARS claims management computer program including all financial aspects of the STARS claims computer system and the production of financial and loss reports. The Claims Administrative Assistant also inputs new claims into the STARS system and performs other claims related work as directed, including preparation of mailings and other clerical duties.

The Claims Administrative Assistant also provides support to the general operation of CCAP, including specific projects assigned by the Claims and Medical Manager, and other similar duties.

General Responsibilities: The Claims Administrative Assistant’s general responsibilities include:

Printing, proofing, obtaining appropriate signatures and mailing all Pcomp, PCoRP and TPA claims checks, in a timely manner based on the parameters established by the CCAP Claims Manual. Matching the Eob’s with the appropriate check and the monitoring of recurring payments. Processing the deductible billings and mailing to the broker and county. Input the deductible payments into STARS under the appropriate claim.

Developing and printing STARS claims systems reports for internal use of CCAP insurance programs staff, including loss information. Process and print the monthly aggregate reports. Process, print and mail the quarterly loss runs to the counties and brokers. Set up and maintain quarterly loss run notebooks for the entire insurance staff. Assist in the process of any adhoc reports requested by insurance staff or brokers. Run reports for and compile the aggregate excess report.

Opening and distributing all daily mail for Pcomp and PCorp adjusters.

Providing back up phone answering for the CCAP insurance programs office.

Copying, collating, and preparing mailings to CCAP members.

Filing, correspondence and other administrative duties.

Performing other assignments and routine business of the association.

Qualifications: Qualifications for the Claims Administrative Assistant

The Claims Administrative Assistant position requires:

A high school diploma, and

1 to 3 years experience.

Must have familiarity with windows software or claims management system.

Excellent oral, written communication, organizational and computer skills.

Essential Physical Requirements:

The essential physical requirements of this position relate to the requirement to be able to operate computer equipment essential to the completion of the position’s responsibilities.

Periodic travel to board meetings, committee meetings, CCAP workshops and conferences throughout Pennsylvania may be required.

FLSA

For the purpose of the Fair Labor Standards Act this is a nonexempt position.

Created January 2002

Revised November 2004

Lynnette L. McHenry provided the following information

ICRMP

Claims Assistant

Reports To: Claims Manager

Supervises: Non-supervisory position

Definition: Administrative support staff for the claims department along with direct administrative support to the Claims Manager

Basic Job Responsibilities:

a.  Assist the Claims Manager and claims staff with various secretarial tasks, including computer-generated reports and drafting basic letters.

b.  Handle and route all calls, mail, emails, faxes and other correspondence for the claims department.

c.  Handle small first-party claims.

d.  Setup and distribute claims to all claims staff.

e.  Pay bills directly associated with claims, print checks and other reports as requested by claims staff and accounting department.

f.  File and maintain filing system.

g.  Copy, print photos and other duties as needed by the claims staff.

h.  Assist claims manager in administrative tasks as requested.

Skills:

1.  Provide administrative support to manager and support the claims staff.

2.  Have experience in administrative and clerical procedures and responsibilities.

3.  Ability to handle multiple phone lines.

4.  Ability to communicate effectively with customers, members and co-workers.

5.  Must have current PC skills.

6.  Excellent customer service skills.

7.  Must be a cooperative team player.

8.  Excellent time management skills and have the ability to prioritize tasks.

9.  Excellent organizational skills in atmosphere with frequent interruptions.

10.  Ability to work well under pressure.

11.  Willingness to attend trainings and other events as requested.

12.  Willingness to perform other duties and responsibilities as needed.