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.


Requirements include:

• 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

Schedule: Regular

Shift: Standard

Employee Status: Individual Contributor

Job Type: Full-time

Job Level: Day Job

Travel: No

Job Posting: Oct 12, 2017, 3:11:49 PM