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Free job description Claims Adjuster
In this example a Medical-Only Claims responsible for the timely initiation of all new injury claims for Members. In addition, will provide accurate claims processing of all non-disability claims from filing to closure in accordance with Fund best practices and state regulation. The Medical-Only Claims Adjuster will also work closely with Insurance Fund staff, Member County staff, injured employees, and medical providers.
10. Review, investigate, analyze, and adjust workers’ compensation claims in accordance with current laws and regulations.
11. Coordinate case transfer from non-disability claim level to disability claim level with Claims Specialist and Director, when applicable.
12. Stay apprised of current law changes, court rulings, and related matters that might affect the handling of claims.
13. Review progress of claims with members, providing a well documented action plan and acting as a resource for claims questions and guidance.
14. Regularly handles private and proprietary information while maintaining strict confidentiality and protecting from unauthorized disclosure.
15. Will require overnight travel and attending trainings and meetings as necessary.
16. Keep Workers’ Compensation Director apprised of any and all claims requiring special attention, or that have extenuating circumstances involved.
17. Perform various routine clerical duties, utilizing standard office equipment to include, but not limited
to the following: maintaining calendars; entering information into databases and spreadsheets; making
photocopies; faxing documents; typing; and word processing.
18. Perform other duties as assigned by Workers’ Compensation Director.
KNOWLEDGE & SKILLS:
1. Knowledge of the entire claims administration, case management and cost containment solutions
as applicable to Workers' Compensation rules
2. PC literate, including Microsoft Office (Word, Excel)
3. Effective analytical and interpretive skills
4. Strong organizational & interpersonal skills
5. Ability to work in a team environment
6. Ability to work independently
7. Excellent oral and written communication skills
EDUCATION: Two year degree at an accredited college preferred but not required.
LICENSES: Possession of a current certification as an Experienced Medical-Only Claims Adjuster, and
proof of current Post-Designation training.
EXPERIENCE: Three (3) years of Workers’ Compensation medical-only claims experience required.
Experience working with public entities preferred but not required.
1. Evaluate First Reports of Injury and ensure that processing is complete
2. Initiate “Three-Point Contact” with Member County, injured employee and medical provider.
3. Initiate and coordinate timely and accurate processing of new work injury claims.
4. Initiate, coordinate and ensure early return-to-work efforts with worker and member.
5. Ensure timely and accurate liability decisions and benefit provision on medical-only injury claims.
6. Provide claims adjusting support to Workers’ Comp Director and Claims Adjuster.
7. Proactively manage and control medical only case inventory.
8. Process compensation payments as directed by Director and Claims Adjuster.
9. Authorize medical treatment within his/her authority level.