Cigna Medical Only WC Adjuster(Claims Adjuster Sr Assoc) Qual-Lynx in Piscataway, New Jersey
The Medical Only Adjuster investigates, adjusts and pays Medical Only Workers’ Compensation claims in a timely manner in accordance with legal statutes, policy provisions and company guidelines.
• Contact the employer and medical provider or nurse case manager upon receipt of claim to confirm/secure details of Workers’ Compensation claim.
Provide timely and accurate information to employer.
• Determine if the claim is compensable in accordance with the applicable jurisdiction.
• Complete all state required forms pursuant to applicable jurisdiction requirements.
• Identify the treating physician to confirm the nature and extent of the injury. Refer to treating physicians in connection with or in lieu of Nurse Case Manager.
• Prepare and provide bills for re-pricing to the approved MCO (Managed Care Organization) vendor, where applicable.
• Accurately and efficiently pay medical bills related to claim.
• Maintain appropriate Medical Only diary, pursuant to our Best Practices.
• High School Diploma required
• knowledge of client and carrier claims procedures; understanding of self-insured retention excess reporting highly preferred
• proficiency with MS Excel and Word required; computer experience with related claims software preferred
• excellent verbal and written communication skills required
• ability to multi-task required
• good negotiation skills required
• strong organizational skills required
• customer-focused orientation required
• strong analytical skills required
Primary Location: Piscataway-New Jersey
Work Locations: 30 Knightsbridge Road Piscataway 08854
Job: Bus Ops--Claims
Employee Status: Individual Contributor
Job Type: Full-time
Job Level: Day Job
Job Posting: Oct 12, 2017, 3:11:49 PM