Occupational Accident Medical Only Claims Adjuster / Workers Compensation Adjuster / Paralegal / Legal Assistant

Blue Star Claims LLC is a Third-Party Administrator specializing in Occupational Accident Claims throughout the United States. This is an excellent opportunity to work in a growing and dynamic work environment. We believe in delivering a high-quality work product to our clients with emphasis on communication and service. We believe in providing an environment where employees enjoy coming to work every day, provide the resources needed to perform their job and assign manageable caseloads. The Occupational Accident Claims Adjuster is responsible for the investigation and adjustment of assigned Occupational Accident claims.

ESSENTIAL DUTIES AND RESPONSIBILITIES: 

·      Investigate and adjust occupational accident claims in accordance with established claims handling procedures using Blue Star guidelines and supervision.

·      Review medical, legal and miscellaneous invoices to determine if reasonable and related to the ongoing occupational accident claims.

·      Authorize and make payment of occupational accident claims utilizing our claim processing protocol in accordance with policy language and within authority levels.

·      Process medically necessary and related bills according to Policy provisions

·      Make supported and educated claim decisions timely.

·      Forecast potential exposure for reserving claims.

·      Have continued contact with policyholders.

·      Negotiate settlements, if appropriate pursuant to the terms of the policy and within authority levels

·      Deliver quality claim service to clients and be responsive to client needs.

·      Familiarize yourself with jurisdiction challenges you may face and be mindful of potential exposure.

·      Manage your time efficiently and utilize your attention to detail to every claim you work on

·      Use established forms and modify letters pursuant to Policy provisions.

·      Review and document medical records outlining treatment plan, restrictions and plan of action.

·      Able to identify mechanism of injury vs symptoms vs non-related conditions.

·      Policy review and administration of benefits pursuant to policy terms

·      Manage claim to optimal resolution; paying for what we owe with relation to the policies we administer.

·      Establish valuable relationships with our Insureds / Motor Carriers / Brokers / Providers / Preferred Vendors

·      Work as a team player

·      Be flexible, use initiative and work with minimum of direct supervision.

·      Use discretion and confidentiality required.

·      Clearly communicate verbally and/or in writing both internally and externally

·      Be organized, a self-starter and prioritize your duties with attention to detail.

·      Perform other duties as assigned.

REQUIREMENTS: 

·      At least two years of experience in some manner of medical type claims, or claims adjusting.

·      Microsoft Office experience

·      Completion of our pre-employment assessment via the link below. https://www.ondemandassessment.com/link/index/JB-87PS9BLTA?u=93138