Claims Adjuster - Sr. Work's Compensation
Greenville, South Carolina (US)
Handle a caseload of approximately 170 pending Medical Only claims. Requires establishing facts of loss, coverage analysis, investigation, compensability/liability/negligence determination, coordination of medical care, identifying potential fraud & appropriate use of authorized vendors. Includes timely & appropriate reserve analysis and payment of medical bills. File handling must be within state statutes, Client Claims Handling Guidelines & NARS Best Practices.
Essential Duties & Responsibilities:
- Identify, analyze and confirm coverage.
- Manage Medical Only WC claims to conclusion within state statutes and guidelines.
Customer Service/Contact:
- Contact appropriate parties & providers to determine compensability & subrogation potential.
- Contact appropriate parties to obtain any needed information & explain benefits as appropriate.
- Continue contact during life of file as appropriate.
- Answer phones, check voice mail regularly & return calls as needed.
- Assist management when required with projects or leadership as requested.
Subro:
- Refer all files identified with subrogation potential to the subrogation department.
Investigation:
- Verify facts of loss & pertinent claims facts such as employment, wages, or damages & establish disability with treating physicians as appropriate.
Qualifications:
Technical skills:
- Advance level of interpersonal skills to handle sensitive/confidential situations & information.
- Requires advanced ability to work independently, an advanced level of organization, time management skills & advanced level written & verbal communication skills.
Abilities:
- Requires long periods of sitting, working indoors in environmentally controlled conditions,
- Lifting of files/boxes up to 20#, use of keyboard/mouse & exposure to computer screens,
- Travel as assigned.
JOB OVERVIEW
Company:
Job Title:
Claims Adjuster - Sr. Work's Compensation
Category:
Claims
Salary:
Not specified