Workers Compensation Claims Assistant

Texas PRIMA; Houston (TX); On-site; USD 32,000 - 42,000; Full time

Benefits offered by this job

Comprehensive medical, dental, and vis

Company contributions to HSA and FSA

401(k) with company match

PTO and company holidays

Learning and development opportunities

Employee assistance resources

Job summary

AvonRisk is seeking a Clerical Claims Support professional to provide operations support to Claims Specialists. You will prepare new claim files, calculate benefits, issue payments and notices, and manage communications with providers and employers.

The role emphasizes accuracy, organization, and teamwork within a collaborative claims environment.

Qualifications

• High school diploma or GED; or 1-2 years related experience and/or training.
• Strong problem-solving, communication, and organizational skills.
• Ability to perform essential clerical duties with accuracy and reliability.

Responsibilities

• Prepares new claims files.
• Calculates TTD, Wage Loss, VRMA and PD benefits.
• Issues compensation payments on diary schedule.
• Issues Benefit Notices.
• Doctor status calls and Employee/Employer contact calls.
• Employer contact calls to confirm light duty/modifies work.
• Prepares litigation documents such as C&R, Stipulations, Answers, etc.
• Handle calls from providers about unpaid bills and related questions.
• Review mail and process direct pays bills such as mileage reimbursement.
• Set up income benefit check schedules under supervision.
• Draft template letters to support the adjusting team.
• Document incoming medical records and notifications in RIS.
• Other clerical functions, as assigned.

Skills

Problem Solving

Customer Service

Team Work

Education

High school diploma or GED

Job description

AvonRisk is the nation’s leading specialty risk manager for self-insured organizations, uniting respected regional leaders in workers’ compensation, liability, managed care, and risk management across 32 states. With nearly 700 professionals and brands including Intercare, InterMed, George Hills, and AS&G Claims Administration, we’re a people-focused, operations-driven organization that prioritizes reasonable caseloads, strong training, collaborative teams, and expert support. We invest in tools and workflows that reduce friction—not increase volume—and create real career paths for professionals who want to grow their careers or move into leadership. At AvonRisk, you’re part of a team that values good judgment, curiosity, and accountability, and gives you the support to succeed.

Summary:

Reports directly to the unit Claims Supervisor but takes primary direction for the assigned Claims Specialist(s). Responsible for providing clerical operations support to assigned Claims Specialist(s).

Essential Duties and Responsibilities:

• Prepares new claims files
• Calculates TTD, Wage Loss, VRMA and PD benefits
• Issues compensation payments on diary schedule
• Issues Benefit Notices
• Doctor status calls and Employee/Employer contact calls
• Employer contact calls to confirm light duty/modifies work
• Works closely with Claims Specialist to complete clerical assignments
• Prepares litigation documents such as C&R, Stipulations, Answers, etc
• Prepares rehabilitation forms for filing with the rehabilitation unit
• Handle calls from providers inquiring about unpaid bills and bill related questions
• Review Mail and process direct pays bills such as Mileage Reimbursement
• File and Serve duties (as needed)
• Notepad documentation in Portal

• Set up income benefit check schedules under the close supervision of the handling adjuster
• Mail claim documents and checks in a timely manner
• Draft template letters (Plain Language Notices) to support the adjusting team
• Document incoming medical records
• Set notifications of document receipt to adjusters from within the Risk Management Information System
• Other clerical functions, as assigned

Requirements

Competency:

To perform the job successfully, an individual should demonstrate the following competencies:

• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Team Work - Supports everyone's efforts to succeed.

Qualification Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience:

High school diploma or general education degree (GED); or 1-2 years related experience and/or training; or equivalent combination of education and experience.

Benefits:

We take care of our people so they can take care of their work and their teams. AvonRisk offers a competitive, people first benefits package designed to support your health, financial security, and career growth, including:

• Comprehensive medical, dental, and vision benefits
• Company contributions to HSA and FSA plans
• Employer paid life and disability insurance
• 401(k) with company match
• Paid time off (PTO) and company paid holidays
• Learning and development opportunities that support real career advancement
• Employee assistance resources and a supportive culture that values balance and wellbeing

We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.

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