New Jersey WC Claims Adjustor 1 in Egg Harbor, New Jersey at Coventry

Coventry
New Jersey WC Claims Adjustor 1

US-NJ-Egg Harbor

Job ID: 24-16960
Type: Regular Full-Time
# of Openings: 1
Category: Customer Service & Support
Mitchell International, Inc.

Overview

The Enlyte Family of Businesses

Mitchell | Genex | Coventry

Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Our suite of products and services enable our employees to help people recover from challenging life events, while providing opportunities for meaningful impact and career growth.

Responsibilities

This position is a hybrid role and you must reside in New Jersey as this position has potential to return partially to the office.

• Contacts the employer and medical provider or Nurse Case Manager upon receipt of claim to confirm/secure details of the New Jersey Workers’ Compensation claim.
• Contacts employees when required and provides timely and accurate information to employer.
• Determines if the claim is compensable in accordance with the applicable legal jurisdiction.
• Identifies the treating physician to confirm the nature and extent of the injury. Refers to treating physicians in connection with or in lieu of Nurse Case Manager.
• Oversees medical treatment and communicates to employer.
• Completes all state required forms pursuant to applicable jurisdiction requirements.
• Sets appropriate reserves to pay medical treatment on accepted claims.
• Prepares and provides medical bills for repricing to the approved MCO (Managed Care Organization) vendor, where applicable.
• Obtain approval for medical treatment payment consistent with client protocols.
• Accurately and efficiently pay medical bills related to claim.
• Maintains appropriate Medical Only diary, pursuant to our Best Practices.

Qualifications

Minimum Education:

High School Diploma or Equivalent

Associates Degree Preferred

Required Skills and Experience:

1-2 Years Workers' Compensation Claims Experience

Microsoft Excel and Word

Desired Skills and Experience:

Medical Terminology

Written Communication Skills

Salary: