Hybrid WC Medical-Only Claims Adjuster - Complex

Selective Insurance; Charlotte (NC); Hybrid; USD 55,000 - 68,000; Full time

Job summary

Selective Insurance is seeking a WC Complex Med Only Adjuster for our Charlotte office. This hybrid role requires 2 days in office and 3 days remote, with experience handling claims in IA, IL, IN, KS, MI, MO, WI.

Responsibilities include investigating medical-only claims, determining coverage, managing reserves, and ensuring compliance with regulations across jurisdictions. Excellent communication and analytical skills are essential.

Qualifications

• Knowledge of workers' compensation statutes, coverage, and case law.
• Excellent written and verbal communication skills.
• Working knowledge of medical treatment and terms related to medical-only workers' compensation claims.
• Critical thinking to assess compensability of WC claim.

Responsibilities

• Receives assigned complex medical-only claims for investigation and determine coverage and appropriate action.
• Establishes initial and subsequent reserves on complex medical-only claims.
• Processes claims including contact, setting reserves, evaluating exposure, and timely payments.
• Documents claim files and maintains control of work through a diary system.
• Manages medical-only claims with potential nurse consults, diagnostics, and procedures.
• Files state forms timely in accordance with statutory guidelines.
• Ensures compliance with company, state, and federal regulations and accurate data for electronic interchange.
• Handles disputed facts, benefits, compensability, coverage, and relatedness.
• Receives assigned claims from the unit or coordinators.

Skills

Communication skills

Medical terminology

Critical thinking

Education

College degree preferred

1-3 years claims experience preferred

Heartland region claims experience required

Job description

Selective Insurance is seeking a WC Complex Med Only Adjuster for our Charlotte office. This hybrid role requires 2 days in office and 3 days remote, with experience handling claims in IA, IL, IN, KS, MI, MO, WI.

Responsibilities include investigating medical-only claims, determining coverage, managing reserves, and ensuring compliance with regulations across jurisdictions. Excellent communication and analytical skills are essential.