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Workers Compensation Medical Only Adjuster

Coverys East Lansing Full-Time
Annual Bonus
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Workers Compensation Medical Only Adjuster

Position Summary

Responsible for the management of multi-state medical only claims from inception to resolution.

Determines compensability through investigation, manages medical direction to claim resolution

Position Purpose & Objective / Focus

This position is responsible for the management of medical only claims from inception to resolution. This includes investigation, determination of compensability, evaluation of medical treatment relatedness, management of associated medical bills and reports.  This position maintains all appropriate documentation as and where defined. The position communicates with all relevant parties to provide customer and client support and produce case resolution. This position is responsible for the claim management of both insured and self-insured client claims. 

Essential Duties & Responsibilities

  • Conducts investigation to determine claim compensability. 

  • Initiates, responds to, and maintains appropriate communication and contact with all involved parties.

  • Reserves cases as appropriate and within assigned authority of within direction of claim manager.

  • Reviews and contributes to medical direction of case.

  • Deploys resources as approved and required to facilitate claim management or resolution.

  • Maintains thorough and appropriate documentation of all claim activities in approved and defined applications.

  • Maintains thorough and appropriate records of claim data.

  • Reviews all bills and medical reports and supporting documentation for determination of claim relatedness and appropriateness.

  • Creates or directs creation of all relevant state related forms.

  • Complies with state specific statutory requirements and timeframes.

  • Complies with all procedural requirements.

  • Identifies and escalates issues, where appropriate.

  • Maintains and presents professional consultative role with clients and vendors that may include limited travel.

  • Reviews files as defined for ongoing management and closure.

  • Contributes to WCS department activities and initiatives where feasible

Education, Requirements & Competencies

  • High School Degree

  • 5 years of claim experience

  • Must  have basic medical terminology and treatment protocol knowledge

  • Michigan or reciprocal state independent license

  • Knowledge and experience in insurance, medical terminology and treatment protocols preferred. 

  • Excellent communication, time management, and critical thinking skills

Coverys is an equal-opportunity employer. Coverys’ job openings are open to all without regard to race, color, national origin, gender, gender identity, religion, age, height, weight, disability, political beliefs, sexual orientation, marital status, family status, or veteran status.

Recommended skills

Critical Thinking
Time Management
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