Claims Adjuster - Medical Only

A Brief Overview

The medical only claims adjuster responsibilities include determining whether coverage exists in our system for the insured, denying claims ineligible for benefits, and thoroughly investigating the claim by interviewing the injured worker, employer, and medical provider.

How You Will Make an Impact:

• Under close supervision and guidance, works within narrowly defined limits with an impact on departmental results - this requires calling the claimant, insured employer, healthcare provider, and witnesses to determine compensability issues and subrogation potential.
• Resolving issues that are generalized and typically not immediately evident, but typically not complex and within immediate job area.
• Denying any claims that are not covered or do not meet compensability criteria and successfully defending that decision if challenged.
• Actively manage medical only claims to ensure only medical bills appropriate to the claim are paid on a timely basis.
• Managing a diary and completing tasks to ensure that cases are resolved timely and at the right financial outcome.
• Properly setting claim reserves.
• Identifying and directing the assignment and coordination of ex...