Claims Adjustor

At Volt, we pride ourselves in our commitment to excellence. Our client in New Jersey is currently hiring Workers’ Compensation Claims Adjuster Medical Only

Bring your enthusiasm and experience and apply today Become a part of a team that is constantly evolving and creating opportunities for a better tomorrow.

This is a remote position - can sit anywhere in the US Must be familiar with New Jersey Workers Compensation Policies Job Description



Investigates, adjusts and resolves assigned Workers’ Compensation claims in a timely manner in accordance with legal statutes, policy provisions and company guidelines.



KEY RESPONSIBILITIES: (Duties may include, but are not limited to, all or some of the following)

Complete internal training in adjusting medical only workers’ compensation claims.
Evaluate claimant eligibility; communicate with attending physician, employer and injured worker.
Confirm coverage and applicable insurance policy or coverage document and statutory requirements.
Establish compensability status through case investigation and evaluation and application of jurisdictional statutes and laws.
Ensure timely payment or denial of benefits in accordance with jurisdictional requirements.
Identify potential for third party recovery, including subrogation. Pursue the process of reimbursement and complete posting of recovery to the claim file, where appropriate.
Investigate potentially suspect claims, possibly with the aid of a field investigator assignment.
Establish claim reserve levels by estimating the potential exposure of each assigned claim, documenting rationale; maintain and adjust reserves over the life of the claim to reflect changes in exposure.
Manage diary in accordance with Best Practices and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
Close all files as appropriate in a timely and complete manner, maintaining closing ratio as directed by management team.
Oversee and coordinate medical treatment for injured employees and provide information to treating physicians and/or nurse case managers regarding employees’ medical history, health issues, and job requirements; provide direction to assigned nurse case manager where applicable.
Work directly with employers to facilitate return to work, either on a transitional duty or full-time basis.
Complete PARs (payment authorization request) or CARs (claims analysis report) when applicable.
Communicate effectively, verbally and in writing with internal and external parties on a wide variety of claims and account-related issues.
Provide a high degree of customer service to clients, including face to face interactions during claim reviews, meetings and similar account-specific sessions.
Perform other duties as required.



COMPENTENCIES



Confidentiality – Possesses high level and regard for confidentiality.
Dependability – Is trustworthy, reliable and accurate.
Detail Oriented – Focuses on details to obtain a quality work product.
Follows Direction – Acts in accordance with instructions.
Judgment - Forms an opinion objectively and with discretion.
Organization – Is able to plan and carry out activities effectively.
Problem Solving – Evaluates information and situations, approaching and resolving in a timely manner.
Teamwork – Promotes cooperation and commitment within a team to achieve goals.
Time Management – Plans and controls time to effectively accomplish goals.
Work Ethic – Is hard working, diligent, reliable, and has initiative.



QUALIFICATIONS



EDUCATION:

High School Diploma required.
Associate degree preferred, or one or more years of insurance, medical/health, or legal related work experience.
1-2 years of experience handling workers’ compensation claims preferred.



SKILLS: Proficient with MS Excel and Word; computer experience with related claims software; excellent verbal and written communication skills; proven interpersonal skills capable of dealing with all levels of personnel; ability to multi-task; good negotiation skills; superior organizational skills; customer-focused orientation; strong analytical skills; knowledge of Workers’ Compensation legal principles and related claims handling practices preferred; understanding of medical terminology and medical/injury treatments.

Volt is an Equal Opportunity Employer

Pay for this position is $20 -$24 HR.