WC Complex Med Only Adjuster -Charlotte, NC (Hybrid)

Overview Selective Insurance is looking for a WC Complex Med Only Adjuster for our Charlotte office. This is a hybrid role with 2 days in office and 3 days remote. Experience handling claims in IA, IL, IN, KS, MI, MO, WI preferred. Responsibility includes effective and timely communication with employer, employee, and medical provider. Investigate medical only claims to determine coverage, compensability, and subrogation potential based on jurisdictional guidelines. Manage claims in multiple jurisdictions. Continuous review and analysis of these claims to ensure that the reserves are appropriate. Manage administration of benefits and claim resolution. Obtain relevant information necessary for a thorough investigation. Freeze facts of claims and make timely decisions. Provide compelling customer service. All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements. Responsibilities Receives assigned complex medical only claims for investigation through telephone or written communication with insureds, claimants, and providers to determine coverage, compensability, subrogation potential, and appropriate course of action. Handles mostly non-indemnity claims (no lost time within waiting period), medical causality, denied claims (not compensable and not covered), and medical claim petitions. On occasion will manage claims with minimal permancy benefits (indemnity). Establishes initial and subsequent reserves on complex medical only claims with a general exposure of less than $30,000. Processes claims which include the following activities: Making contacts, setting reserves, evaluating claims for exposure, establishing timely reserve adjustments during the life of the file, making timely payments, and resolution. Documents claim files and maintain control of work through documentation or diary system. Manages medical only claims with some complexity that may require a nurse consult, diagnostics, and minor medical procedures. Understand medical terminology and injury mechanism. Ability to recognize comorbidities that may complicate injury and recovery. File state forms timely in accordance with statutory guidelines. Ensures compliance with company, state, and federal regulations. Makes certain data is accurate and updated timely for electronic data interchange with state and Medicare. Handle disputed facts, benefits, compensability, coverage, medical causality, and relatedness. Receives assigned claims from the medical only unit , notice of loss coordinator, or lost time adjusters. Qualifications Knowledge and Requirements Knowledge of workers compensation statutes, coverage, and case law. Excellent written and verbal communication skills. Working knowledge of medical treatment and terms as related to medical only workers compensation claims. Critical thinking skills to assess compensability of WC claim as it relates to the facts and law. Education and Experience College degree preferred. 1-3 years claims experience preferred. Total Rewards Selective Insurance offers a total rewards package that includes a competitive base salary, incentive plan eligibility at all levels, and a wide array of benefits designed to help you and your family stay healthy, achieve your financial goals, and balance the demands of your work and personal life. These benefits include comprehensive health care plans, retirement savings plan with company match, discounted Employee Stock Purchase Program, tuition assistance and reimbursement programs, and 20 days of paid time off. Additional details about our total rewards package can be found by visiting our benefits page. Pay Range USD $55,000.00 - USD $68,000.00 /Yr. Additional Information Selective is an Equal Employment Opportunity employer. That means we respect and value every individual’s unique opinions, beliefs, abilities, and perspectives. We are committed to promoting a welcoming culture that celebrates diverse talent, individual identity, different points of view and experiences – and empowers employees to contribute new ideas that support our continued and growing success. Building a highly engaged team is one of our core strategic imperatives, which we believe is enhanced by diversity, equity, and inclusion. We expect and encourage all employees and all of our business partners to embrace, practice, and monitor the attitudes, values, and goals of acceptance; address biases; and foster diversity of viewpoints and opinions. For Massachusetts Applicants It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. #J-18808-Ljbffr Selective Insurance Company of America