Medical Only Adjuster

  • M, WI
  • Claims

Medical Only Adjuster

  • M, WI

Website The James Allen Companies Inc.

GENERAL DESCRIPTION
The medical adjuster independently adjudicates multi-state workers’ compensation medical-only and subrogation claim files that are generally non-catastrophic in nature.
ESSENTIAL FUNCTIONS
1. Receives medical-only assignments. Verifies and determines applicability of coverage. Completes 24 hour contact with employer, employee and attending physician. Recorded statements may be required on questionable occurrences.
2. Reviews all coverage issues and determines compensability within Midwest standards.
3. Responsible for customer relations management, consistently establishing and maintaining high levels of trust and confidence with clients, through constant contacts, prompt response and resolving client’s questions and claim issues.
4. Responsible for scheduling of reserves to Ultimate Probable Cost (UPC), diary maintenance, medical case management, and authorizing payments.
5. Recognizes third party liability and handles subrogation cases through a point of recovery.
6. Closely guards medical only files with increased severity and direction of workflow/authority is retained from the Unit Supervisor.
COMPETENCIES/QUALIFICATIONS
• This individual will possess excellent written, communication and organizational skills, be a good listener, have the ability to multi-task, and stronghold the understanding of human nature and motivation principles.
• Readily control/handle problem issues in times of stress and in a climate of conflict and/or adversity.
• A degree of creativity and latitude is expected, where reliance on experience and judgement is utilized to accomplish tasks.
• Ability to adhere to the code of ethical conduct and recognize the importance of practicing fair claims practice in accordance with the workers’ compensation law.
• Ability to take direction and make decisions.
• Ability to multi-task while also paying attention to detail.
• Ability to work well as part of a team and independently with limited supervision.
• Computer literacy including strong familiarity with Microsoft Office Suite. Ability to type 45 WPM.
EDUCATION/EXPERIENCE REQUIREMENTS
• Minimum Education: High school diploma required, college preferred
• Detail oriented, organized self-starter with a desire for career development within the insurance industry, 1-2 year’s relevant claims processing experience in the workers’ compensation field.

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