Medical Only Claims Adjuster

Questpro Consultants LLC; Charlotte (NC); On-site; USD 55,000 - 70,000; Full time

Job summary

Our client, a growing MGA specializing in Workers' Compensation, is seeking a Medical Only Claims Adjuster to manage claims efficiently while delivering outstanding service. Reporting to the Claims Manager, you will use negotiation and analytical skills to determine payable claims and oversee injured employee care.

Ideal candidates have 2+ years of Medical Only Claims handling, strong independence, and excellent interpersonal abilities.

Qualifications

• 2+ years of Medical Only Claims handling.
• Must be fluent in English; Spanish a plus.
• Adjusters license in one or more states is beneficial.
• Experience adjusting in NC, SC, GA and TN is preferred.

Responsibilities

• Determining coverage on new claims.
• Contacting employer for initial investigation.
• Contacting employee/injured worker for information — recorded statements
• Reviewing medical bills to determine if payment is proper and referral of those bills for audit.
• Filing necessary forms with the Industrial Commission.
• Determining appropriate reserves for claims.
• Determining when claims need medical case management services and arranging the necessary care.
• Corresponding with attorneys on legal issues.
• Attending mediations and hearings.

Skills

Negotiation

Analysis

Independent work

Communication

Job description

Our client is a growing MGA that specializes in Workers Compensation. They are looking for Medical Only Claims Adjuster, where you will be essential in managing claims efficiently while providing outstanding customer service. Reporting to the Claims Manager, you will utilize your core skills in negotiation and analysis to assess claims and ensure compliance with workers’ compensation laws. As a Medical Only Claims Adjuster, you will be investigating claims, determining if the claim is payable and managing the care of the injured employee.

Ideal candidates will have:

• Ability to solve practical problems and to work independently.
• 2+ years of Medical Only Claims handling.
• Ability to be resourceful and prioritize.
• Good interpersonal skills.
• Ability to build and maintain relationships with insureds, injured workers and attorneys.
• Fluent English is required. Spanish speaking is a plus.
• Adjusters License in one or more states a plus
• Has adjusted in two or more of these states: NC, SC, GA and TN

Job Responsiblities:

• Determining coverage on new claims.
• Contacting employer for initial investigation.
• Contacting employee/injured worker for information — recorded statements
• Reviewing medical bills to determine if payment is proper and referral of those bills for audit.
• Filing necessary forms with the Industrial Commission.
• Determining appropriate reserves for claims.
• Determining when claims need medical case management services and arranging the necessary care.
• Corresponding with attorneys on legal issues.
• Attending mediations and hearings.