POSITION TITLE: Claims Adjuster, Medical

JOB CODE: 474C

DIVISION: Human Resources

SALARY SCHEDULE: Office Clerical/Technician Annual

DEPARTMENT: Support Services

WORKDAYS Annual Administrative Employee

REPORTS TO: Assistant Director, Risk Management

PAY GRADE: Rank VI (NC06)

FLSA: Non-Exempt

PAY FREQUENCY: Monthly

PRIMARY FUNCTION: Receives, investigates, and manages medical only Worker's Compensation claims; directs employees to approved medical providers; reviews medical billing for proper charges; composes and types of correspondence; maintains up-to-date files.

Requirements

Educational Level: High School Diploma or GED required

Certification/License Required: None

Experience: 2 or more years of responsible claims processing

Physical Activities: Routine physical activities that are required to fulfill job responsibilities

Knowledge, Skills, & Abilities: Written and oral communication; telephone, public relations; computer skills

The Board of Education and the Superintendent may accept alternatives to some of the above requirements.

Essential Duties

Demonstrates prompt and regular attendance.

Inputs employee injury reports into computer system; confirms employee demographics; sets up claim reserves and updates amount as needed; maintains and updates an average of 800 open medical only files.

Investigates injuries as needed by contacting injured worker, supervisor and witnesses as needed; explains the worker's comp process; determines compensability; requests prior medical records as needed.

Assesses treatment plans from medical providers; authorizes medical treatment; reviews and approves pharmacy, physical therapy and requests for durable medical equipment.

Codes and processes medical invoices for payments and ensures accuracy/appropriateness of charges; performs weekly batching of comp payments; verifies and calculates mileage forms submitted by injured workers for reimbursements.

Researches and negotiates best price on durable medical equipment with vendors; assists with composing the Panel of Physicians.

Reviews medical reports for work/disability status and refers claims to lost time examiner when lost time results.

Attends continuing education seminars/classes on worker's comp medical and legal topics; maintains CWCP certification (Certified Worker's Comp Professional).

Answers telephone, assists and routes calls to appropriate individual; composes and types of correspondence.

Performs other duties as assigned by appropriate administrator.

Cobb County School District

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