Associate Claims Examiner

We need to output HTML fragment with sections: About the role? Actually we have company details, responsibilities, qualifications, benefits, sponsorship details. The instruction: use

for section headings (e.g. About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule). We need to include sections only when posting has real specific content. We have company details (maybe "About the company" but not listed as heading; we could use "About the role"? Actually "About the role" is generic; but we have company details and responsibilities. We could use "About the role" for responsibilities? But they said do NOT repeat the job title as a heading. The job title is "Associate Claims Examiner (ACE)". Not needed. We need sections: Responsibilities, Qualifications, Benefits, maybe Pay (they gave salary range). Pay is present: Base Salary Range: $60,000 – $80,000 annually. So we should include Pay section. Schedule not mentioned, so omit. Skills maybe not explicit; we have qualifications includes skills. Could combine Qualifications and Skills? But they said prefer few substantive sections over many thin ones. We could have sections: Responsibilities, Qualifications (including education, experience, skills), Benefits, Pay. Also maybe "About the Company" but not required; they said use headings like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We could use "About the role" for company details? But they said do NOT repeat the job title as a heading; but "About the role" is okay. However they said include a section ONLY when the posting has real, specific content for it. The posting includes company details; we could put that under "About the role" or maybe "About the company". Since they gave example headings, we can use "About the role" to describe the role and company. But we also have responsibilities separate. Might be redundant. Better to have sections: Responsibilities, Qualifications, Benefits, Pay. Also maybe "Company Details" not in list; but we could incorporate into Qualifications? Not ideal. Could add "About the role" covering company details and role overview. Let's see: The posting starts with company details, then responsibilities, qualifications, benefits, sponsorship details. So we could have:

About the role

with company details and brief role overview (maybe first paragraph). Then

Responsibilities

with list.

Qualifications

with list.

Benefits

with list.

Pay

with paragraph. We must not include schedule. Also remove boilerplate: equal opportunity employer, unsolicited resumes note, sponsorship details (maybe we can include sponsorship details? It's not a standard heading; but we could drop it as it's minor metadata. They said fold minor metadata into a short

or drop it. Sponsorship details is minor; we could drop or include in a short p under Qualifications? Probably drop. We need to preserve all substantive information: company details, responsibilities list, qualifications list, benefits list, pay range. Let's extract details. Company Details paragraph: "Preferred Employers Insurance, A Berkley Company specializes in providing workers’ compensation insurance to California business owners. The company serves three major Product/Client Segments: Small Business, Mid-Larger Businesses and Group Association Members (Programs). The company’s distribution partners (agents & brokers) number just under 400 locations throughout the state. Preferred serves thousands of policyholders and provides medical claims handling and claims management as needed to care for injured workers. The company is rated A+ Superior by industry-rating organization, AM Best & Company. Company URL: https://www.peiwc.com" We should keep that. Responsibilities: The block after "Responsibilities". Need to list duties as

• . The responsibilities paragraph includes many sentences; we need to break into list items. The instruction: Use
  • for any list of duties/requirements/benefits. So we should convert the responsibilities into list items. Probably each sentence or clause becomes a li. We need to preserve all substantive information; not invent or summarize away detail. So we need to capture each duty. Let's parse responsibilities section: "The Associate Claims Examiner (ACE) utilizes general understanding of department’s operation and objectives. They are responsible for entering claim indemnity payments, SROI filing, issue Benefit Notices, complete void/stop payment, and reissuing of checks with a 99% timeliness goal. The ACE position will provide customer service to the claims department, and assist Claims Technical and Operations with other duties as needed and as time allows. This position will make inquiries with claims examiners, medical providers and injured workers, as needed, to assess return to work status and determine whether further payments should be issued. This position acts in a fiduciary role on behalf of insureds in assessing the need for indemnity payments. Job functions are considered routine and predefined and require minimum evaluation. The ACE administers the payment of benefits with the utmost, good faith, in compliance with the rules, regulations and statutes of the State of California and the WCAB. The ACE must be a team player. This position requires particular attention to detail, and is often task-oriented. This position will require 120 hours of classroom training at Supervisor’s direction within the first year in position in order to obtain Experienced Examiner Certification. 30 hours of continuing education every two years is required to maintain that certification." Then "Key Responsibilities Include But Are Not Limited To" followed by list: - Make indemnity payments to claimants, both lump sum and ongoing payments, including initial, final and retroactive periods. - Issue Benefit Notices as required with regards to the start, changing and ending of benefits. - Will issue Permanent Disability denials in certain circumstances and notify claims examiner with an Activity. - Transmit Second Report of Information (SROI) to the State of California as required. - Gather and document information from medical providers on disability status of claimants. - Referral to Return to Work Coordinator who will gather and document information from insureds on return to work status of their injured employees as well as availability of modified or alternate duties. - Follow up on return to work status, through coordinator, until an offer is made or a final decision not to accommodate is made. - Refers cases as appropriate to management by setting an activity for review. - Maintains professional client relationships. - Timely and appropriate notification to examiner on cases with indemnity payments, on need for appropriate reserves to ensure adequacy for life of claim. - Coordinate and process void, stop pay, and reissue Indemnity payments. - Offer and, if accepted, enroll claimants in our EFT program. - Attend Examiner Certification training as directed by Supervisor. - Upon certification as an Experienced Examiner, additional duties may be added including, but not limited to, drafting of settlement documents and calculation of wage statements. - Assist technical and operations with other duties as needed and as time allows. We need to combine the earlier paragraph responsibilities with the key responsibilities list, ensuring no duplication. Some items repeat: entering claim indemnity payments, SROI filing, issue Benefit Notices, void/stop payment, reissuing checks. Those appear also in list. We should deduplicate but preserve all info. Could just use the list as the responsibilities; it's more detailed. The earlier paragraph also includes some generic statements like utilizes general understanding, provide customer service, assist technical/operations, make inquiries, fiduciary role, routine functions, administer payment, team player, attention to detail, task-oriented, training requirements. Those are not in the list; we should include them as separate li items. Thus responsibilities list will include: - Utilizes general understanding of department’s operation and objectives. - Provides customer service to the claims department and assists Claims Technical and Operations with other duties as needed and as time allows. - Makes inquiries with claims examiners, medical providers and injured workers to assess return to work status and determine whether further payments should be issued. - Acts in a fiduciary role on behalf of insureds in assessing the need for indemnity payments. - Job functions are considered routine and predefined and require minimum evaluation. - Administers the payment of benefits with the utmost good faith, in compliance with the rules, regulations and statutes of the State of California and the WCAB. - Must be a team player. - Requires particular attention to detail and is often task-oriented. - Requires 120 hours of classroom training at Supervisor’s direction within the first year to obtain Experienced Examiner Certification. - Requires 30 hours of continuing education every two years to maintain that certification. - Makes indemnity payments to claimants, both lump sum and ongoing payments, including initial, final and retroactive periods. - Issues Benefit Notices as required regarding the start, changing and ending of benefits. - Issues Permanent Disability denials in certain circumstances and notifies claims examiner with an Activity. - Transmits Second Report of Information (SROI) to the State of California as required. - Gathers and documents information from medical providers on disability status of claimants. - Refers to Return to Work Coordinator who gathers and documents information from insureds on return to work status of their injured employees and availability of modified or alternate duties. - Follows up on return to work status through coordinator until an offer is made or a final decision not to accommodate is made. - Refers cases as appropriate to management by setting an activity for review. - Maintains professional client relationships. - Provides timely and appropriate notification to examiner on cases with indemnity payments and on need for appropriate reserves to ensure adequacy for life of claim. - Coordinates and processes void, stop pay, and reissue indemnity payments. - Offers and, if accepted, enrolls claimants in the EFT program. - Attends Examiner Certification training as directed by Supervisor. - Upon certification as an Experienced Examiner, may perform additional duties including drafting of settlement documents and calculation of wage statements. - Assists technical and operations with other duties as needed and as time allows. We need to ensure no duplication: "Assist technical and operations with other duties as needed and as time allows." appears twice (once in earlier paragraph and at end). We'll keep one. Now Qualifications: "Bachelor degree from an accredited college or university preferred 2+ years of related administrative office work experience. Strong written and verbal communication skills, attention to detail and deadline structures. Ability to work both independently and collaboratively with all levels of staff. Proficient with MS Office software and PC applications and systems. Baccalaureate degree from an accredited college or university preferred Knowledge of workers’ compensation principles and policies equivalent preferred." There's some repetition: Bachelor degree preferred, Baccalaureate degree preferred (same). We'll combine. We'll produce list: - Bachelor’s degree (or Baccalaureate) from an accredited college or university preferred. - 2+ years of related administrative office work experience. - Strong written and verbal communication skills. - Attention to detail and ability to meet deadline structures. - Ability to work both independently and collaboratively with all levels of staff. - Proficient with MS Office software and PC applications and systems. - Knowledge of workers’ compensation principles and policies preferred. Now Benefits: "The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include: Base Salary Range: $60,000 – $80,000 annually Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment." We need Benefits section (list) and Pay section (maybe separate). Benefits list: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k), Prof