Workers’ Compensation Medical Only Claims Adjuster

Position Title: Workers’ Compensation Medical Only Claims Adjuster
Reports to: Workers’ Compensation Claims Supervisor
Classification: Exempt

Position Summary:
Responsible for the handling of workers’ compensation medical only and minor lost time claims within assigned reserve authority under the direction and authority of the Workers’ Compensation Claims Supervisor.

Work is performed under the general supervision of the Workers’ Compensation Claims Supervisor. This is sedentary to light work that requires limited physical effort; position requires visual acuity for preparing, reviewing, checking and maintaining written and computer files and records; requires hearing sufficient to accurately perceive information at normal spoken word levels, the ability to express or exchange ideas by means of the spoken word and manual dexterity to operate standard office, data entry and word processing equipment.

  • Investigates and determines compensability of medical only and minor lost time claims.
  • Communicates with members, injured employees, and medical providers.
  • Evaluates exposures and establishes appropriate reserves within reserve authority of $25,000.
  • Meets EDI filing requirements with KY Department of Workers’ Claims.
  • Calculates wage loss benefits and issues timely payments.
  • Develops concise action plan for resolution of claim.
  • Reviews and approves medical treatment/bills.
  • Maintains electronic claim file.
  • Ensures claim files are properly documented and coding is correct.
  • Supports other claim representatives.
  • Responds timely to all request.
  • Ensures continuity of each member and allows for the solvency of the insurance program.
  • Identifies subrogation potential and assists subrogation adjuster during recovery process.
  • Fosters networking and relationship building with members.
  • Performs related tasks as required.

Knowledge, Skills and Abilities: Basic knowledge of Kentucky Workers’ Compensation Statutes and Regulations and knowledge of claim handling procedures preferred; ability to communicate ideas effectively both orally and in writing; familiarity with medical terminology; strong computer skills; proficient in Microsoft Office products; ability to work in paperless environment; strong time management skills; and ability to establish and maintain effective working relationships with others.

Education and Experience:
Any combination of education and experience equivalent to graduation from an accredited college or university with major course work in business administration or related field. Two (2) years of insurance experience desired but not required.

Special Requirements:
Possession of an appropriate driver’s license valid in the Commonwealth of Kentucky. Kentucky Adjuster’s license desired, but not required.

Applicants should submit their resume and salary requirements to Martha Cosby via our contact form by 5:00 p.m. Friday, April 5, 2019.  No phone calls please.