Work Comp Adjuster

Transtar Insurance/Bluestar Claims•Phoenix, AZ

7d•$45,000 - $65,000

About The Position

Blue Star Claims LLC is a third-party administrator specializing in occupational accident claims throughout the United States. The Occupational Accident Claims Adjuster investigates and adjusts assigned occupational accident claims in accordance with established claims-handling procedures, Blue Star guidelines, policy provisions, and assigned authority levels. The role reviews medical records and invoices, assesses whether treatment and charges are reasonable and related to the claim, makes timely and supported claim decisions, processes or authorizes eligible payments, forecasts claim exposure for reserving, and manages claims toward optimal resolution. The position involves ongoing communication with policyholders, clients, insureds, motor carriers, brokers, providers, and preferred vendors. The adjuster may negotiate settlements when appropriate and within authority, review policy provisions and administer benefits, identify injury mechanisms and distinguish them from symptoms or unrelated conditions, document treatment plans and restrictions, and use established forms and policy-compliant correspondence. The role requires organization, attention to detail, discretion, confidentiality, initiative, flexibility, teamwork, and the ability to work with minimal direct supervision. The average medical-only caseload is up to 150 claims.

Requirements

High school diploma or equivalent.
At least two years of experience in medical-type claims, claims adjusting, paralegal work, or legal assistant work.
Experience with Microsoft Office.
Completion of the pre-employment assessment through the link provided in the posting.

Responsibilities

Investigate and adjust assigned occupational accident claims according to established procedures, Blue Star guidelines, and supervision.
Review medical, legal, and miscellaneous invoices to determine whether they are reasonable and related to ongoing claims.
Authorize and make claim payments under the claim-processing protocol, policy language, and assigned authority levels.
Process medically necessary and related bills according to policy provisions.
Make timely, supported, and informed claim decisions.
Forecast potential claim exposure for reserving.
Maintain continued contact with policyholders.
Negotiate settlements when appropriate under policy terms and within authority levels.
Deliver quality claim service and respond to client needs.
Familiarize yourself with jurisdictional challenges and consider potential exposure.
Manage time efficiently and apply attention to detail to each claim.
Use established forms and modify letters in accordance with policy provisions.
Review and document medical records, including treatment plans, restrictions, and plans of action.
Identify the mechanism of injury and distinguish it from symptoms and unrelated conditions.
Review policies and administer benefits according to policy terms.
Manage claims to optimal resolution, paying covered amounts under the administered policies.
Build relationships with insureds, motor carriers, brokers, providers, and preferred vendors.
Work as a team player; demonstrate flexibility and initiative and work with minimal direct supervision.
Use required discretion and maintain confidentiality.
Communicate clearly, verbally and in writing, with internal and external contacts.
Stay organized, self-start, prioritize duties, and maintain attention to detail.
Perform other duties as assigned.