Medical Only Adjuster

SUMMARY

Adjusts medical-only workers’ compensation claims within designated handling authority to conclusion.  Assists claims staff in the administrative functions in reporting of new claims, verification of claim status and state required filings.  May serve as entry level claims adjuster responsible for payment of simple medical only WC and P&C claims.  This position is an entry-level technical position and works closely with and may assist a Claims Adjuster, Senior Claims Adjuster or a Supervisor.   

JOB REQUIREMENTS:

• Determines coverage, compensability and if necessary transfers claim
• Determines potential subrogation and if cannot be resolved within 6 months, file is transferred to adjuster
• Utilizes appropriate vendor(s) for medical bill review
• Processes medical payments
• Must have basic knowledge of current principles and practices associated with claims investigations
• Must be able to understand oral and written policies, procedures or instructions
• Ability to handle confidential medical information
• Assists adjusters with required state filings
• Maintain appropriate registers
• Complete data entry, check issuance and vouchers
• Maintain policy status information, required logs, and monthly reports
• General clerical duties – i.e. providing support to adjusters by sending faxes, letters, wage statements, contact cards, etc.
• May include other assigned duties

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

• Ability to understand and follow oral and/or written policies, procedures and instructions
• Ability to perform a wide variety of duties and responsibilities with accuracy and speed, while meeting time-sensitive deadlines
• General knowledge of claims and ability to identify claims of urgent priority
• Must have good oral and written communication skills
• Excellent telephone and customer service skills
• Good understanding of personal computers and ability to use various software programs
• Ability and willingness to learn new skills and knowledge brought about by rapidly changing information and/or technology

Required Experience: 

Prefer to have 2-5 years experience in claims office or equivalent business experience.   Should have basic knowledge of insurance coverages.   Must have high school diploma or equivalent.