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.
