Medical Only Claims Adjuster

Medical Only Claims Adjuster Position Description

 

In the role of Medical Only Claims Adjuster for Workers' Compensation, you will be essential in managing claims efficiently while providing outstanding customer service. Reporting to the Claims Manager, you will utilize your core skills in negotiation and analysis to assess claims and ensure compliance with workers' compensation laws. As a Medical Only Claims Adjuster, you will be investigating claims, determining if the claim is payable and managing the care of the injured employee.

Attributes include:

• Ability to solve practical problems and to work independently.
• 2+ years of Workers Compensation Claims handling.
• Ability to be resourceful and prioritize.
• Good interpersonal skills.
• Ability to build and maintain relationships with insureds, injured workers and attorneys.
• Fluent English is required. Spanish speaking is a plus.
• Adjusters License in one or more states a plus
• Has adjusted in two or more of these states: NC, SC, GA and TN

The position involves:

• Determining coverage on new claims.
• Contacting employer for initial investigation.
• Contacting employee/injured worker for information – recorded statements
• Reviewing medical bills to determine if payment is proper and referral of those bills for audit.
• Filing necessary forms with the Industrial Commission.
• Determining appropriate reserves for claims.
• Determining when claims need medical case management services and arranging the necessary care.
• Corresponding with attorneys on legal issues.
• Attending mediations and hearings.