This individual is responsible for handling from inception to completion work related injuries that do not involve any lost time from work. The Medical Only Claims Adjuster is responsible for maintaining current file documentation, which coincides with the progression of the file; must be able to communicate effectively orally and in writing to direct and monitor the medical treatment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Primary Duties • Document all incoming medical reports. • Contact the employer to confirm no lost time and identify red flags. • Review the medical reports for accuracy and consistency in relation to the employer's report
and the original body part that was injured. • Review claims every 30 to 45 days to ensure file progression. • Authorize medical treatment, physical treatment, diagnostic testing, and medications. • Willing to learn multiple jurisdictions
The Medical Only Adjuster investigates, adjusts and pays Medical Only Workers' Compensation claims in a timely manner in accordance with legal statutes, policy provisions and company guidelines. Contact the employer and medical provider or nurse case manager upon receipt of claim to confirm/secure details of Workers' Compensation claim. Provide timely and accurate information to employer. • Determine if the claim is compensable in accordance with the applicable jurisdiction. • Complete all state required forms pursuant to applicable jurisdiction requirements. • Identify the treating physician to confirm the nature and extent of the injury. Refer to treating
physicians in connection with or in lieu of Nurse Case Manager. • Prepare and provide bills for re-pricing to the approved MCO (Managed Care Organization)
vendor, where applicable. • Accurately and efficiently pay medical bills related to claim. • Maintain appropriate Medical Only diary, pursuant to our Best Practices. • Perform other duties as required
Required Skills
SKILLS/ABILITIES: • Ability to prioritize and juggle multiple tasks simultaneously • Effective communicator both orally and in writing • Strong customer service focus • Strong organizational skills, thoroughness, accuracy and attention to detail. • Good communication skills, verbal and written. • Basic computer skills. • Experience with MS Excel and Word.
KNOWLEDGE • Familiarity with workers compensation medical terminology.
Required Education and Experience • BS / BA or Equivalent Work Experience • 1 Year Claims Support adjusting experience preferred • (State) Adjuster License preferred
Competencies
A. Thoroughness.
B. Technical Capacity.
C. Problem Solving.
D. Customer Service Oriented
E. Teamwork
Work Environment
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee is required to frequently sit; work using a computer; interact with customers (by phone and/or email); use hands to finger, handle or feel; and reach with hands and arms.
Position Type/Expected Hours of Work
This is a full-time position. Standard days and hours of work are Monday through Friday, 8:30 a.m. to 5 p.m. Based on business needs this may change.
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.