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

Overview

A Third-Party Administrator specializing in Occupational Accident Claims across the United States is seeking an Occupational Accident Claims Adjuster. This role involves investigating and adjusting assigned occupational accident claims while delivering high-quality service and communication to clients.

Responsibilities

• Investigate and adjust occupational accident claims following established claims handling procedures and guidelines
• Review medical, legal, and miscellaneous invoices to verify reasonableness and relation to ongoing claims
• Authorize and process payments for occupational accident claims according to claim processing protocols, policy language, and authority levels
• Process medically necessary bills in accordance with policy provisions
• Make timely, supported, and educated claim decisions
• Forecast potential exposure for reserving claims
• Maintain ongoing contact with policyholders
• Negotiate settlements when appropriate, pursuant to policy terms and authority levels
• Deliver quality claim service and respond to client needs
• Understand jurisdictional challenges and potential exposures
• Manage time efficiently and apply attention to detail to each claim
• Use established forms and modify letters as per policy provisions
• Review and document medical records, outlining treatment plans, restrictions, and plans of action
• Identify mechanism of injury versus symptoms and non-related conditions
• Review policies and administer benefits according to policy terms
• Manage claims to optimal resolution, paying only what is owed under administered policies
• Establish and maintain relationships with insureds, motor carriers, brokers, providers, and preferred vendors
• Work collaboratively as a team player
• Demonstrate flexibility, initiative, and ability to work with minimal supervision
• Maintain discretion and confidentiality
• Communicate clearly both verbally and in writing internally and externally
• Stay organized, self-motivated, and prioritize duties with attention to detail
• Perform other duties as assigned

Requirements

• High school diploma or equivalent
• Minimum of two years' experience in medical claims, claims adjusting, paralegal, or legal assistant roles
• Proficiency with Microsoft Office
• Completion of a pre-employment assessment

Caseload

• Average caseload for medical-only claims: up to 150

Compensation & Benefits

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

Location

• United States (remote or specific location not specified)