Claims Adjuster, Medical Only

Overview: The Worker’s Compensation Medical Only Claims Adjuster is responsible for the prompt and effective investigation of worker’s compensation claims involving injuries that require medical treatment but no wage loss.

Claim adjudication requires interaction with Insureds, claimants, medical providers and other parties to ensure adequate medical treatment is provided while utilizing Company resources in a cost-effective manner.

Responsibilities: Ability to multitask and prioritize work in a fast-paced environment and manage time effectivelyInvestigates losses of low to moderate severity to determine cause, scope and extent of injury and/or liability for potential subrogationVerifies coverage and confirms policy conditions have been metObtains missing information and ensures data integrity for Regulatory reportingCommunicates effectively with claimants, policyholders, Underwriters, agents, and other internal and external stakeholdersAuthorizes medical treatment and schedules medical appointments.Establishes medical reserves, approves medical bills and reviews/requests medical recordsDocuments all correspondence, reports, discussions and decisions in Claim file notesKnowledge of multiple state jurisdictions (if applicable)Obtain appropriate Adjuster licensing (If applicable)Performs other related duties as assigned Qualifications: RequiredProficiency with MS Word, Excel and other business applicationsDemonstrated skills in critical thinking and independent decision making12 Training hours needed annuallyState licensing requirements (if applicable)Preferred:Minimum of 2 years handling Medical Only or other Workers Compensation Claims experienceBasic knowledge of medical conditions, treatment plans and casual relation to occupational injury/illness

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