What are the responsibilities and job description for the Medical Only Claims Adjuster position at Questpro?
- Location: Kansas City, MO
- Type: Questpro - Contingent
- Job #20968
Questpro, a leading Insurance recruiting firm, is partnered with a Specialty Insurance Carrier that’s seeking a MEDICAL ONLY WORKERS COMPENSATION ADJUSTER for their corporate office in Kansas City, MO.
This role is an entry level position and the company will provide training. Open to Customer Service Reps, Account Managers, and Administrative Professionals.
The medical-only claims adjuster plays a critical role in our connections and interactions with our policyholders and agency partners. They are involved in handling claims that require the facilitation of medical treatment including surgery when no impairment is anticipated.
Claims adjusters interact with multiple departments (i.e. Loss Control, Underwriting, Marketing) within the company to provide quality claims handling and mitigate exposure on claims.
Essential Functions
- Performs initial review of claim and confirms appropriate tasks are set to push claim to closure
- Facilitates treatment referrals in a timely manner pending the manner it was received (phone message/email vs faxed order)
- Communicates significant information to employers such as when an injured worker has been referred to a specialist, reserves changes, and claim closure.
- Sets appropriate reserves; reviews and adjusts throughout the life of the claim as appropriate
- Reviews and processes bills in a timely manner
- Requests medical records and work statuses from provider
- Facilitates subrogation proceedings on claims involving third-party negligence in an effort to obtain maximum recovery
- Identify and discuss with supervisor when a claim has met criteria to be escalated to lost time
- Regularly reviews and updates claim status reports as facts of the claim change (i.e. reserve changes, significant medical updates, etc.)
- Timely response to incoming emails from employers and medical providers
- Works with lost time adjusters to coordinate specialist referrals
- Handles some surgical claims where no impairment is anticipated
- Obtains and documents all necessary forms per state statute (i.e. Form 50)
- Communicates with agency partners to provide claim updates, facilitate claim reviews, and work closely to maintain successful/exceptional relationship with mutual insured
- Review claim file to ensure all bills are paid and task to close claim in a timely manner
- Provide thoughtful & thorough written correspondence both internally and externally.
- Accountability for meeting various deadlines related to the responsibilities of the position and managing various tasks throughout the day
- A proactive approach to claims handling; a result-oriented individual.
- Embraces the core values of our organization
- Attention to detail
- Ability to communicate often and effectively with supervisor and peers.
