Blue Star - Medical Only Occupational Accident Claims Adjuster/Work Comp Paralegal or Legal Assistant/Work Comp Adjuster

Overview

This role involves investigating and adjusting assigned Occupational Accident claims for the organization. The position focuses on delivering high-quality claim service through effective communication, timely claim decisions, and adherence to established claims handling procedures.

Responsibilities

• Investigate and adjust occupational accident claims in accordance with established claims handling procedures and the organization’s guidelines and supervision.
• Review medical, legal, and miscellaneous invoices to determine whether charges are reasonable and related to the ongoing occupational accident claims.
• Authorize and make payment of occupational accident claims using the organization’s claim processing protocol, in accordance with policy language and within authority levels.
• Process medically necessary and related bills according to policy provisions.
• Make supported and educated claim decisions in a timely manner.
• Forecast potential exposure for reserving claims.
• Maintain continued contact with policyholders.
• Negotiate settlements, if appropriate, pursuant to the terms of the policy and within authority levels.
• Deliver quality claim service to clients and respond to client needs.
• Familiarize yourself with jurisdiction challenges and be mindful of potential exposure.
• Manage time efficiently and apply attention to detail to every claim.
• Use established forms and modify letters pursuant to policy provisions.
• Review and document medical records, including treatment plan, restrictions, and plan of action.
• Identify mechanism of injury versus symptoms versus non-related conditions.
• Perform policy review and administer benefits according to policy terms.
• Manage claims to optimal resolution by paying for what is owed under the administered policies.
• Establish and maintain relationships with insureds/motor carriers/brokers/providers/preferred vendors.
• Work collaboratively as a team player.
• Be flexible, use initiative, and work with minimum direct supervision.
• Use discretion and maintain required confidentiality.
• Communicate clearly verbally and/or in writing both internally and externally.
• Stay organized, be a self-starter, and prioritize duties with attention to detail.
• Perform other duties as assigned.

Requirements

• High school diploma or equivalent.
• At least two years of experience in some manner of medical type claims, claims adjusting, paralegal, or legal assistant work.
• Microsoft Office experience.
• Completion of the organization’s pre-employment assessment.

Compensation & Benefits

• Competitive salary with potential performance-based bonuses.
• Medical, dental, and vision insurance.
• 401(k) with company match.
• Paid time off and holidays.
• Professional development opportunities.

Caseloads (Average)

• Medical Only: up to 150