Volt is immediately hiring for Medical Claims Adjustor inEgg Harbor, New Jersey (Remote) Must Live in NEW Jersey, New York or PA
Medical Benefits Included
As a Medical Claims Adjustor, you will:
Evaluate claimant eligibility; communicate with attending physician, employer and injured worker.
Work with the claimant and their physician to medically manage the claim, from initial medical treatment to reviewing and evaluating ongoing medical treatment and related information.
Work directly with employers to facilitate return to work, either on a full-time or modified duty basis.
Confirm coverage and applicable insurance policy or coverage document and statutory requirements.
Identify potential for third party recovery, including subrogation, Second Injury Fund or other fund involvement (when applicable) and excess or reinsurance reimbursement. Pursue the process of reimbursement and complete posting of recovery to the claim file, where appropriate.
Identify potential for disability or pension credits or offsets.
Assign field adjuster investigation on potentially suspect claims.
Ensure timely denial or payment of benefits in accordance with jurisdictional requirements.
Establish claim reserve levels by estimating the potential exposure of each assigned claim, establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure.
Establish compensability status through case investigation and evaluation and application of jurisdictional statutes and laws.
Where litigation is filed, evaluate exposure and work closely with defense counsel to establish strong defenses, prepare litigation plan of action, set legal reserve and manage litigation over life of claim.
Manage diary in accordance with Best Practices and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
Close all files as appropriate in a timely and complete manner.
Maintain closing ratio as directed by management team.
Oversee and coordinate medical treatment for injured employees and provide information to treating physicians regarding employees' medical history, health issues, and job requirements; provide direction to assigned nurse case manager where applicable.
Complete PARs (payment authorization request) when applicable
This is a Full-Time opportunity.
The ideal candidate will have:
• Confidentiality - Possesses a high level and regard for confidentiality.
• Dependability - Is trustworthy, reliable, and accurate.
• Detail Oriented - Focuses on details to obtain a quality work product.
• Follows Direction - Acts in accordance with instructions.
• Judgment - Forms an opinion objectively and with discretion.
• Organization - Is able to plan and carry out activities effectively.
• Problem Solving - Evaluates information and situations, approaching and resolving in a timely manner.
• Teamwork - Promotes cooperation and commitment within a team to achieve goals.
• Time Management - Plans and controls time to effectively accomplish goals.
• Work Ethic - Is hard working, diligent, reliable, and has initiative.
Salary:$20.00 - $21.00 per hour
Pay range offered to a successful candidate will be based on several factors, including the candidate's education, work experience, work location, specific job duties, certifications, etc.
Qualified candidates should APPLY NOW for immediate consideration! Please hit APPLY to provide the required information, and we will be back in touch as soon as possible.
Volt is an Equal Opportunity Employer and prohibits any kind of unlawful discrimination and harassment. Volt is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment on the basis of race, color, religion or belief, national origin, citizenship, social or ethnic origin, sex, age, physical or mental disability, veteran status, marital status, domestic partner status, sexual orientation, or any other status protected by the statutes, rules, and regulations in the locations where it operates. If you are an individual with a disability and need a reasonable accommodation to assist with your job search or application for employment, please contact us at hr_dept@volt.com. Please indicate the specifics of the assistance needed.
Volt does not discriminate against applicants based on citizenship status, immigration status, or national origin, in accordance with 8 U.S.C. § 1324b.
