A Medical Only Adjuster is a professional who works closely with professionals to determine the validity of workers’ compensation claims that involve only medical workers’ compensation benefits. Roles and responsibilities commonly found on the Medical Only Adjuster Resume are – providing customer service, answering telephone calls and redirecting callers as necessary; evaluating coverage and determining compensability; performing data entry to set up new claims, completing and preparing documentation for referrals, managing initial and subsequent treatment with the medical provider network; and assisting in the delivery of medical care in accordance with utilization review, and using appropriate cost containment techniques including strategic vendor partnerships to reduce the overall cost of claims.
The nature of the job demands the following skills and abilities – strong organizational and analytical skills, exemplary written and verbal communication skills; interpretive skills, and PC literacy. An associate’s degree in a relevant field is commonplace among job applicants.
Summary : As a Medical Only Adjuster, responsible for Working within the insurance industry to increase my knowledge in other areas of insurance while utilizing my customer services knowledge and skills.
Skills : Windows Vista, Windows XP, Mac, Access, PowerPoint, Work, Quick books, AS400, Novell, Types 55 WPM, 10 key calculator.
Description :
Managed files up reserves, Determined compensability, manage the Medical treatment and any Subrogation.
Kept communication with the Client and injured worker to resolve the claim to completion.
Filed any required forms.
Kept plan of actions updated in a timely manner.
Authorized and managed medical bills and daily Diary.
Set up claims within our system.
Made contacts on each new file.
Experience
10+ Years
Level
Senior
Education
High School Diploma
Medical Only Adjuster Resume
Summary : Medical Only Adjuster with 14 years experience. Familiar with commercial and private insurance carriers. Expertise includes ICD9 and CPT coding. Patientfocused skilled at medical billing, coding and office management. Reliable multitasker with anesthesia and pain management coding experience.
Skills : Microsoft Office, Windows, Windows 10.
Description :
Evaluated the first report of injury and ensure processing is complete.
Contacted all members involved.
Processed compensation payments.
Authorized medical treatment with authority level.
Assisted adjusters with documents for their claimants.
Scanned mail to each adjuster in the company.
Copied files that needed to be sent out each day.
Experience
10+ Years
Level
Senior
Education
Associate In General Studies
Medical Only Adjuster Resume
Headline : As a Medical Only Adjuster, responsible for Accepting new cases from customers, Ensuring that cases are handled in a timely manner while adhering to company guidelines, ensuring that all documents are filed properly, including case notes and insurance forms, and also Providing customer service when needed.
Able to verify lost time, waiting periods and wage loss.
Processed benefits daily to avoid penalty and interest.
Processed manual bill payments.
Handled bill/claim calls.
Maintained current file documentation including all incoming medical reports Established contact with employer to confirm no lost time claims and no .
Handled and maintained workman's comp medical only claims, enter medical notes, process bills, call providers, claimants.
Managed Medical until injured worker is MMI or file reaches qualified status for Loss Time file.
Experience
5-7 Years
Level
Executive
Education
High School Or Equivalent
Medical Only Adjuster Resume
Summary : Experience in managing high volume FMLA, Medical Leave of Absence, and Maternity Leave claims Understanding of basic workers compensation calculations, handling incoming workers compensation claim for local TPA companies Bachelors Degree of Science n Business/Human Resource Management.
Skills : Computer, Claims Processing, Customer Service, Negotiation, Medical Terminology, Data Entry.
Description :
Handled new losses for Judicial Branch Workers Compensation Program.
Determined AOE/COE.
Investigated and evaluated medical only claims, coordinated early return to work, determine and pay benefits owed, and establish action plans that lead to the resolution of claims.
Communicated with insurers, medical providers, attorneys, and injured workers.
Complied with rules and regulations of the state.
Sent out new claim benefits to employees/claimants.
Handled medical-only Workers' Compensation claims from beginning to end Handle recovery as well as return checks.
Experience
7-10 Years
Level
Management
Education
High School Or Equivalent
Medical Only Adjuster Resume
Headline : Self-motivated individual who takes great care in her work, especially one that requires the constant use of own initiative. A team leader with excellent leadership skill and who is waiting for the perfect opportunities to become a Claims Supervisor. A Claims Supervisor who is not only will to give directions in the file, but one who is willing to work the file with my team, giving them the tools needed to exceed and accomplish their daily duties.
Skills : Certified Medical Interpreter Spanish, Medical Skills.
Description :
Adjusted claim files in 26 states to determine compensability.
Made three point contacts.
Established and maintained appropriate reserve.
Maintained claim diaries, Identify and aggressively manage work status, facility NCM, medical treatment, return to work strategy, wage calculations.
Identified and refered to subrogation to investigate for potential third party involvement, transfer all litigated claim file to Gallagher Bassett for lost time claim handling.
Maintained a 100% closure rational, and bring all medical only claim file to a complete resolution, as well as maintain cost contingency.
Set up new claims, established and maintained proper coding and data per company and client requirements.
Experience
5-7 Years
Level
Executive
Education
MS
Medical Only Adjuster Resume
Summary : As a Medical Only Adjuster, responsible for Completing timely reviews of all medical records, Ensuring all documentation is completed accurately and in a timely manner, and Following up with insurers when necessary for review or resolution of an issue, Communicating with patients/clients about their claim status as needed.
Skills : MS Office, Vendor.
Description :
Handled medical only workers compensation claims.
Responsible for opening and closing files.
Responsible for reviewing and paying medical bills.
Contacted clients, claimants, and providers.
Worked with multiple vendors and setting up appointments.
Responsible for telephone management of phone calls with proper etiquette.
Worked on a team of adjusters and being back-up for other co-workers.
Experience
7-10 Years
Level
Management
Education
High School Diploma
Medical Only Adjuster Resume
Summary : As a Medical Only Adjuster, responsible for Providing guidance to adjusters for all aspects of the process, Conducting quality assurance reviews on adjusters' work, Identifying opportunities for improvement in the claims resolution process, Working with the field to identify opportunities for improvement in the claims resolution process, Working with field to identify new business development opportunities.
Skills : Microsoft Office, Medisys Software.
Description :
Maintained established treatment guidelines for workers' compensation diagnostics and surgeries and ensure physicians are aware of current treatment guidelines utilized by the various carriers.
Set or recommended reserves based on results of claim investigation.
May provided interaction with insureds, agents, claimants, attorneys, and other service providers.
Conducted in-depth interviews and/or scene inspections.
Worked closely with physicians to coordinate causation letters and appeals when compensability is disputed.
Assisted in ensuring the timely payment of benefits, medical and vendor bills and processed state required filings.
Maintained effective and ongoing communication within the office and with outside parties.
Experience
7-10 Years
Level
Management
Education
BS In Finance
Medical Only Adjuster Resume
Summary : As a Medical Only Adjuster, responsible for Processing medical claims and managing claim payments, providing oversight for the company's policyholders and coordinating service, Developing compliance strategies that meet regulatory requirements, Managing a team of adjusters, and providing training.
Skills : Employee Management, Monitoring Skills.
Description :
Set up claim files by assigning numbers, verifying information on injury form, setting amount of medical reserves required for injury; enter information into computer system using GenSource.
Evaluated and authorized payment and issue checks to doctors, hospitals, pharmacies and all other vendors providing service on a claim, code all bills, verify accuracy of bill to type of injury and determine reasonableness of charges.
Advised employee injured on the job of their rights and benefits as to proper procedures to file a claim.
Contacted physician, employer and employee to initiate early return to work dates at temporary light duty jobs; Monitor medical progress and set up exams with medical providers, as well as requesting up-to-date narrative reports of status.
Verified all industrial leave hours and dollars; verify employee went to doctor and/or was off on legitimate industrial accident time; if hours appear excessive, contact department for reason.
Independently determined what hours are appropriate and approve for payment.
Perform all related duties and responsibilities as required.
Experience
7-10 Years
Level
Management
Education
Bachelors
Medical Only Adjuster Resume
Objective : To obtain a Medical Only Adjuster, responsible for Assisting clients in receiving the appropriate coverage for their healthcare services, Assisting clients in understanding their benefits and payment options, Assisting client in pursuing reimbursement from insurance companies, and also Completing tasks assigned by the claims manager.
Skills : Multitasking, Analyzing Skills.
Description :
Worked Medical Only Worker's Compensation claims.
Processed medical bills for payment.
Worked within specific limits and authority on assignments of moderate technical complexity.
Used discretion and independent judgment in claim handling
Possessed functional knowledge and skills reflective of fully competent practitioner.
Identified possibly suspicious claims
Investigated, analyzed, evaluated and negotiated personal and/or commercial lines claims of minimal to moderate complexity.
Experience
2-5 Years
Level
Executive
Education
High School Diploma
Medical Only Adjuster Resume
Objective : Medical Only Adjuster is responsible for Creating a claim file for each case and gathering the necessary information to process the claim, Investigating the claim to determine the cause and potential solutions, and Following up with the client or patient to ensure they are satisfied with the resolution of their claim.
Skills : Interpersonal Skills Medical Skills, Coordinating Skills.
Description :
Responsible for managing all aspects of each claim and maintaining a high level of productivity, confidentiality and customer service.
Implemented and coordinated the most effective management techniques to mitigate loss and expense payments.
Reserved and expensed authority levels are moderate.
Worked with the Special Investigations Unit, where appropriate.
Knowledged of medical terminology.
Cultivated an environment of teamwork and collaboration
Operated with latitude for un-reviewed action or decision.
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