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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