Medical Only Claims Adjuster

About the role

The organization operates in the commercial insurance industry, focusing on providing affordable and accessible insurance solutions tailored for small businesses. It addresses the challenge of complex and costly commercial insurance by utilizing technology to simplify the purchasing and claims experience for its customers. The MEDICAL ONLY CLAIMS ADJUSTER role is critical to managing workers' compensation medical only claims efficiently and ensuring a high-quality claims experience. This position is responsible for overseeing claims from initiation to closure, working with various stakeholders to mitigate risks and achieve favorable outcomes. The role supports the organization's commitment to regulatory compliance and customer service excellence.

Responsibilities

• Independently manage all aspects of workers' compensation medical only claims.
• Conduct timely investigations focusing on medical management and claim closure.
• Mitigate claim exposure to achieve optimal outcomes.
• Make compensability decisions within statutory requirements.
• Set and adjust claim reserves accurately and timely.
• Administer statutory medical benefits throughout claim lifecycle.
• Utilize Utilization Review when appropriate and ensure timely payment of medical bills.
• Comply with all applicable statutory guidelines and regulations.
• Identify and escalate claims that may convert to indemnity.
• Resolve medical treatment issues to close claims promptly.
• Manage lien resolution claims and negotiate settlements.
• Serve as a contact for agents and customers regarding claim guidance and status.
• Provide excellent customer service and advocate for a leading claims experience.
• Continuously improve claims operations and identify service gaps.

Requirements

• High school diploma or equivalent required.
• Bachelor's degree or some college coursework preferred.
• Minimum one year of experience as a Medical Only Adjuster handling workers' compensation claims.
• At least one year of experience handling claims in California.
• Experience in Arizona and Utah preferred.
• Proficient written and verbal communication skills.
• Awareness of task impact on team deliverables.
• Experience with G-Suite and collaboration tools like Slack preferred.
• Knowledge and experience in claim adjudication and medical management.
• Ability to analyze multiple data points and take appropriate actions.
• Conflict resolution skills to achieve beneficial outcomes.
• Ability to make claim decisions that mitigate exposure while optimizing results.

Benefits

• Comprehensive health plans.
• Generous paid time off.
• Future-focused 401(k) match.
• Generous parental and caregiver leave.

Pay

Base compensation range $60,000 to $75,000 USD. Competitive cash compensation. Discretionary bonuses may be granted annually based on company performance.