Medical Only Occupational Accident Claims Adjuster/Work Comp Paralegal/Legal Assistant
Job Description:
- Investigate and adjust occupational accident claims in accordance with established claims handling procedures using Blue Star guidelines and supervision
- Review medical, legal and miscellaneous invoices to determine if reasonable and related to the ongoing occupational accident claims
- Authorize and make payment of occupational accident claims utilizing our 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 timely
- Forecast potential exposure for reserving claims
- Have 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 be responsive to client needs
- Familiarize yourself with jurisdiction challenges you may face and be mindful of potential exposure
- Manage your time efficiently and utilize your attention to detail to every claim you work on
- Use established forms and modify letters pursuant to Policy provisions
- Review and document medical records outlining treatment plan, restrictions and plan of action
- Able to identify mechanism of injury vs symptoms vs non-related conditions
- Manage claim to optimal resolution; paying for what we owe with relation to the policies we administer
- Establish valuable relationships with our Insureds / Motor Carriers / Brokers / Providers / Preferred Vendors
- Work as a team player
- Be flexible, use initiative and work with minimum of direct supervision
- Use discretion and confidentiality required
- Clearly communicate verbally and/or in writing both internally and externally
- Be organized, a self-starter and prioritize your duties with attention to detail
- Perform other duties as assigned
Requirements:
- Highschool diploma or equivalent
- At least two years of experience in some manner of medical type claims, claims adjusting, paralegal or legal assistant.
- Microsoft Office experience
- Completion of our pre-employment assessment via the link below.
Benefits:
- Competitive salary and potential performance-based bonuses
- Medical, dental, and vision insurance
- 401(k) with company match
- Paid time off and holidays
- Professional development opportunities
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