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Medical Only Adjuster

Employer
Davies Claims Solutions
Location
Nashville, Tennessee
Salary
Salary commensurate with experience. Excellent benefits package offered.
Closing date
Apr 6, 2021

View more

Category
Claims
Job Type
Full Time
Career Level
Experienced (Non-Manager)

Job Details

SUMMARY

Adjusts medical-only injury on duty claims using the TN workers’ compensation statute as a guide, along with client specific special handling instructions.  Claims within designated handling authority are handled to conclusion.  This position requires at least 3 years medical only claim handling experience.  This adjuster will be required to work at the client’s on site medical clinic in the “fill in” rotation with existing claim adjusters, senior claim adjusters and supervisor.   

JOB REQUIREMENTS:

  • Determines coverage, compensability and if necessary transfers claim
  • Three point contact required on all medical only claims
  • Identifies potential subrogation and notifies the client’s legal department/designated entity
  • Utilizes appropriate vendor(s) for medical bill review, case management, pharmacy, etc. per client’s special handling instructions
  • Processes medical payments on correct file
  • Must have basic knowledge of current principles and practices associated with claims investigations
  • Must be able to understand oral and written policies/procedures and instructions
  • Ability to handle confidential medical information
  • May include other assigned duties

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

  • Ability to understand and follow oral and/or written policies, procedures and instructions
  • Ability to perform a wide variety of duties and responsibilities with accuracy and speed, while meeting time-sensitive deadlines
  • General knowledge of claims and ability to identify claims of urgent priority
  • Must have good oral and written communication skills
  • Excellent telephone and customer service skills
  • Good understanding of personal computers and ability to use various software programs
  • Ability and willingness to learn new skills and knowledge brought about by rapidly changing information and/or technology

Required Experience: 

Prefer to have 3-5 years experience in claims office or equivalent business experience.   Should have basic knowledge of insurance coverages.   Must have high school diploma or equivalent.

Company

Davies Claims Solutions provides TPA services for a variety of insurance clients and self-insured entities including public entities and private employers with employees in many states. 

The workers’ compensation TPA claims handling process includes a number of services such as nurse case management, nurse triage, medical bill review, pharmacy benefit management, telemedicine, medical provider options, return-to-work initiatives, peer review, utilization review and more. 

 

As a TPA, we provide a number of flexible client options, such as choice of nurse case management, medical provider access with PPO networks or Alternative Cost Containment, and a choice of surveillance and claims investigation. We also offers telemedicine as a managed care solution. 

 

Our U.S. claim adjusters, have an average of 25 years of industry experience.  We have a strong track record of delivering excellent financial outcomes for our clients such as averaging indemnity savings of almost a third through our pharmacy benefit management.

 

Company info
Website
Location
2501 McGavock Pike, Suite 802
Nashville
TN
37214
US

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