Auto No-Fault/Medical Only Workers' Compensation Adjuster
JOB SUMMARY
The Auto No-Fault/Medical Only Workers' Compensation Adjuster investigates, evaluates, and negotiates the settlement of first-party personal injury protection (no-fault) claims and workers' compensation medical only claims in a prompt, cost-effective manner. This position also provides administrative and technical support to the workers' compensation unit.
primary responsibilities include:
- Handles new injuries by contact appropriate parties and establishes rapport
- Makes telephone or written contact with employer, claimant, medical provider, attorney, and/or agent
- Reviews medical reports and invoices for proper codes and procedures
- Analyzes and interprets information to assess proper resolution of claim
- Determines necessity of and makes assignments for independent medical exams, peer reviews, surveillance, and attorney involvement
- Calculates wage loss based on time lost and policy coverage
- Maintains diary of claims
- Maintains and sets adequate reserves
- Indexes injuries to check for prior injury and compliance with Medicare reporting
- Manages workload consistent with current workload standards and assistants others as needed
- Performs monthly unit stat checks and keys appropriate information
- Ensures regulatory compliance
- Performs other miscellaneous duties as assigned or directed.
minimum job requirements:
- High school diploma or general equivalency
- Minimum of three years' experience in related position(s)
- Strong customer service orientation
- Demonstrated ability in dealing with people
- Demonstrated analytical and problem-solving skills
- Proficient interpersonal relations and communications skills (both written and verbal)
- Proficient organization skills and the ability to set schedules and meet deadlines
- Moderate computer skills
- General knowledge of insurance and claims law
- Understanding of claims adjusting process
- Knowledge of medical terminology
- Working knowledge of workers' compensation regulations
- Ability to interpret insurance contracts, medical reports, damage appraisals, etc.
- Math aptitude.
Additional Information
Full benefits package, including health, dental reimbursement, vision, 401(k) and Roth 401(k), and PTO, starts the first of the month following employment. Please visit our Web site to learn more about us and why you might want to work with us.
Equal Opportunity Employer
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