Workers' Compensation Medical Only Claims Representative (Adjuster)

Job Description

The workers’ compensation medical only claims representative is key to helping MCIT carry out its mission of providing cost-effective coverage with comprehensive and quality risk management services to its members by efficiently and effectively adjusting workers’ compensation claims.

MCIT is a joint powers government entity made up of Minnesota counties and associated public entities that pool resources to provide property, liability, auto and workers’ compensation coverage to members. MCIT offers a collaborative work environment and excellent benefits, including a pension plan.

Core Responsibilities

Under the direction and supervision of the workers’ compensation claims manager, the medical only claims representative is responsible for making payments to physicians, clinics, hospitals, pharmacies and other associated entities for medical treatment of injured employees of MCIT members in cases where no indemnity payments for lost time are required.

Typical Duties

The following are common duties of the medical only claims representative:

·         Receive and review all notices and information from MCIT members regarding work-related injuries and illnesses as assigned by the claims manager.

·         Make initial contact with the employer on a new claim to confirm that the employee has not lost time due to the injury.

·         Make contact with the employer, claimant and/or physician to obtain clarification when appropriate.

·         Receive, review and authorize payment(s) for invoices received from health care providers in claims where no indemnity payment is required and from injured employees for mileage to medical appointments and health care for a work-related injury or illness.

·         Confer with nurse case manager when the mechanism of injury or treatment is questionable.

·         Obtain prior medical records necessary or advised by the nurse case manager or physician consultant.

·         Communicate claim activity and processing to the claimant and the member.

·         Calculate and establish timely and appropriate reserves for claims administered by MCIT.

·         Advise the claims manager of claims that have the potential of subrogation and restitution; file affidavits of restitution when appropriate and follow up.