Medical Claim Adjuster

FCCI Insurance Group•Ridgeland, MS

1d•$23 - $35•Hybrid

About The Position

At FCCI, our people make the difference. Our teammates are committed to upholding FCCI’s long-standing traditions of building relationships, serving others and giving back to the community. Come join us and make a difference! We are seeking a detail-oriented and analytical Medical Claim Adjuster to investigate, evaluate, and manage assigned workers' compensation medical-only claims. In this role, you will determine compensability through thorough investigations, obtain and review medical information, evaluate coverage, establish appropriate reserves, and ensure claims are administered in compliance with applicable statutory regulations and company best practices. The selected candidate can work from either our Sarasota, FL, Lake Mary, FL, Glen Allen, VA, Lawrenceville, GA or Ridgeland, MS office. This is a hybrid eligible role (3 days in office and 2 remote).

Requirements

Detail-oriented and analytical skills
Ability to investigate, evaluate, and manage workers' compensation medical-only claims
Knowledge of determining compensability through thorough investigations
Ability to obtain and review medical information
Ability to evaluate coverage
Ability to establish appropriate reserves
Understanding of applicable statutory regulations and company best practices
Ability to process benefits and complete required statutory filings
Ability to communicate with injured workers, employers, medical providers, and agency partners
Ability to escalate and transfer claims as appropriate
Ability to manage claims efficiently while ensuring accuracy, compliance, and quality customer service

Responsibilities

Investigate and determine compensability for assigned medical-only workers' compensation claims in multiple jurisdictions.
Review medical documentation and monitor treatment to ensure ongoing care is related to the work injury.
Document claim activity, maintain claim files, and establish appropriate reserves.
Process benefits and complete required statutory filings in compliance with applicable laws and regulations.
Communicate with injured workers, employers, medical providers, and agency partners.
Escalate and transfer claims as appropriate based on claim complexity and company guidelines.
Manage claims efficiently while ensuring accuracy, compliance, and quality customer service.