SANTA ANA UNIFIED SCHOOL DISTRICT CLAIMS ASSISTANT BASIC FUNCTION: Under direction, perform a wide variety of complex clerical work requiring specialized knowledge of workers’ compensation, liability and property claims administration. This position performs multiple tasks involving frequent and responsible contact with the medical and legal community. DISTINGUISHING CHARACTERISTICS: The Claims Assistant is a highly skilled claims specialist. Duties are of a complex or diverse nature. The Claims Assistant has thorough knowledge of claims procedures. Incumbents are flexible in responding to a wide variety of claim requests and providing information. Claims Assistants are expected to perform independently. Typically they have responsibility for maintaining office files, answering phones, and processing mail. REPRESENTATIVE DUTIES: Assist Claims Examiner in specific tasks related to workers’ comprehension claim procedures. E Determine off-work status. E Communicate with injured workers and their physicians regarding proper claims procedure. E Evaluate and authorize treatment and payment to medical providers. E Adjust medical claims. E Maintain complex files in an orderly manner. E Match mail to files quickly and correctly. E Handle confidential information including complaints in a professional manner. E Resolve disputes and make decisions in a manner compliant with the California Labor Code and other law concerning workers’ compensation. E Plan, schedule and perform a wide variety of difficult and complex work related to a busy insurance claims office. E Demonstrate a detailed knowledge of rules, procedures and policies pertinent to school district administration. E Operate various office equipment including inputting and retrieving data from modern computer systems. E Perform related duties as assigned. KNOWLEDGE AND ABILITIES: KNOWLEDGE OF: Modern office practices, procedures and equipment including computer equipment. Record-keeping techniques. Modern office communications skills (oral and written). School district organization, operations and objectives. Applicable sections of the State Labor Code and other regulations dealing with insurance. Technical aspects of claims administration. ABILITY TO: Interpret appropriate rules, regulations, and policies. Operate modern office equipment. Make complex arithmetic calculations involving money and percentages. Type 40 words per minute. Establish and maintain effective working relationships with others. Meet schedules and time lines. Work confidentially and with discretion. Perform the essential functions of the job. EDUCATION AND EXPERIENCE: Any combination equivalent to graduation from high school two years' experience working as a claim assistant in a workers' compensation claim office. WORKING CONDITIONS: ENVIRONMENT: Fast-paced office environment. Multiple and simultaneous projects. PHYSICAL ABILITIES: Hearing and speaking accurately to exchange information in person or on the telephone. Seeing to read a variety of materials. Sitting for extended periods of time. Dexterity of hands and fingers to operate a computer keyboard and office machines. Lifting or moving objects, normally not exceeding twenty (20) pounds. Reasonable accommodation may be made to enable a person with a disability to perform the essential functions of the job. Board Approved: (8/99) 5/01