What are the responsibilities and job description for the Work Comp Claims Adjuster (MED-ONLY) position at Elite?
TITLE: Medical Only Claims Adjuster
POSITION SUMMARY
COMPANY has an immediate need for a full-time Medical Only Claims Adjuster to support our workers compensation office in Texas. This position is offered as a fully remote work from home opportunity and the schedule for this position is Monday-Friday at 37.5 hours a week. The Medical Only Examiner will adjust workers’ compensation medical claims, ensure timely processing of claims and payment of benefits, managing and directing medical treatment.
PRIMARY RESPONSIBILITIES
Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:
ESSENTIAL POSITION REQUIREMENTS
The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.
This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training.
COMPANY is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.
COMPANY is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc.
POSITION SUMMARY
COMPANY has an immediate need for a full-time Medical Only Claims Adjuster to support our workers compensation office in Texas. This position is offered as a fully remote work from home opportunity and the schedule for this position is Monday-Friday at 37.5 hours a week. The Medical Only Examiner will adjust workers’ compensation medical claims, ensure timely processing of claims and payment of benefits, managing and directing medical treatment.
PRIMARY RESPONSIBILITIES
Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:
- Review daily diary for claim status
- Review medical reports to determine whether additional medical opinions are needed
- Object to unauthorized medical treatment
- Establish contact with employer to review issues
- Respond to inquiries from the employer, employee, doctors, and attorneys
- Establish and maintain appropriate reserves
- Review medical reports
- Evaluate and approve medical procedures and treatment
- Review medical bills for appropriateness
- Discuss appropriateness of medical treatment with medical case manager
- Prepare and present reports to clients
- Close claims appropriately
- Help resolve client billing and payment inquiries
- Investigate complaints from injured workers
- Document and code the claim files and claims system with all relevant information
- Maintain and update action plans within specified time frames
- Provide customer service and support to clients and claimants
ESSENTIAL POSITION REQUIREMENTS
The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.
- High School Diploma or equivalent (GED) required for all positions
- AA/AS or BA/BS preferred but not required
- 1-2 years’ Texas workers’ compensation claims handling experience required
- Knowledge of Texas workers compensation claims handling procedures
- The Texas 03 Workers’ Compensation license is required
- The 08 All Lines License is preferred
- Proficiency in determining case value and negotiating settlements
- Understanding of medical and legal terminology
- Completion of Insurance Education Association (IEA) or equivalent training
- Designation with current continuing education hours
- Knowledge of workers’ compensation case law, policies, and procedures
- Mathematical calculating skills
- Well-developed verbal and written communication skills with strong attention to detail
- Excellent organizational skills and ability to multi-task
- Ability to type quickly, accurately and for prolonged periods
- Proficient in Microsoft Office Suite
- Ability to learn additional computer programs
- Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
- Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization
- Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
- Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner
- Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor
- COMPANY’s operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.
- Must be able to reliably commute to meetings and events as required by this position
This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training.
COMPANY is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.
COMPANY is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc.