Medical Claims Adjuster

4 weeks ago

Wall Township NJ, United States CCMSI Full time
Job Summary

We are seeking a skilled Medical Claims Adjuster to join our team at CCMSI. As a Medical Claims Adjuster, you will be responsible for handling designated medical-only claims and providing support to the claim staff.

This is a hybrid position that involves adjusting medical-only workers' compensation claims across NJ, NY, MD, PA, DE, and DC. A DE adjuster's license is preferred, and experience with medical terminology and medical-only claims is highly desired.

Responsibilities
  • Set up and manage medical files only in accordance with corporate claim standards and law.
  • Establish reserves and/or provide reserve recommendations within established authority levels under direct supervision.
  • Review and approve related medical and miscellaneous invoices on designated claims. Negotiate any disputed bills/invoices for resolution under direct supervision.
  • Request and monitor medical treatment of designated claims in accordance with corporate claim standards.
  • Summarize all correspondence and medical records in claim log notes as well as file same in the appropriate claim.
  • CLOSE CLAIM FILES WHEN APPROPRIATE.
  • Retrieve closed claim files and re-file in storage, as requested.
  • Provide support to claim staff on client service teams.
  • Compliance with Corporate Claim Standards and special client handling instructions as established.
  • Performs other duties as assigned.
Qualifications

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, skills, and/or abilities required.

Education and/or Experience

Associate Degree or two (2) year's related business experience required

Knowledge of medical terminology preferred.

Computer Skills

Proficient using Microsoft Office products such as Word, Excel, Outlook

Certificates, Licenses, Registrations

DE or NY adjusters license is preferred but not required.

Must pass Adjuster license exam as required for the respective jurisdiction(s).

CORE VALUES & PRINCIPLES

Responsible for upholding the CCMSI Core Values & Principles which include: performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example.

CCMSI is an Affirmative Action/Equal Employment Opportunity employer offering an excellent benefit package included Medical, Dental, Vision, Prescription Drug, Flexible Spending, Life, ESOP and 401K.

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