Claims Adjuster – Medical Only

1 Position available at our Fresno CA location

Summary

Reports directly to the unit Claims Supervisor. In accordance with applicable statutes and in keeping with company rules, regulations, and established performance objectives, is responsible for effectively managing an assigned inventory of medical only claim files.  These files could be assigned at the unit or the department level..

Essential Duties and Responsibilities

  • Perform a three-point contact on all new losses within 24 hours of receipt of the claim to include the claimant, employer, and treating physician to document relevant facts surrounding the incident itself as well as disability and treatment status.
  • Thoroughly and accurately document ongoing case facts and relevant information necessary for establishing compensability, the need for disability payments, the use of vendors, medical and expense payments, and the reason the claim is still open.
  • Promptly transfer to a Claims Specialist any case that appears to have potential issues other than the need for short-term medical treatment.
  • Assure that the claim file is handled completely in accordance with existing and applicable statutes as well as in-force service contracts and company guidelines.
  • Establish, monitor, and adjust monetary case reserves when warranted and in strict accordance with assigned authority levels.
  • Promptly and in accordance with the Labor Code as well as internal processing requirements review all medical bills for appropriateness prior to referral to InterMed for payment and posting to the claim file.
  • Exhibit and maintain a courteous and helpful attitude and project a professional image on behalf of the company.
  • Requires knowledge of the Labor Code of the State of California as it pertains to workers compensation claims and specifically the legal requirements for verifying, processing, and paying medical bills.
  • Respond to telephone messages and inquiries within 24 hours of receipt and to written inquiries within one week of receipt.

Qualification Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

At least 1-3 years experience as a Workers’ Compensation Claims Assistant, or up to one year Trainee or Future Med Adjuster experience; or Bachelor’s degree (B.A.) and six months experience.

Certificates and Licenses

High school diploma or general education degree (GED); or one to three months related experience and/or training; or equivalent combination of education and experience.

 

Qualified candidates who are interested in joining our growing team should email your resume to: HR@Intercareins.com

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