Workers' Comp Claims Adjuster

Insurance Services  
Full Time
Day Shift 
7a-6p (Flex)

Consistently named best hospital, Lexington Medical Center dedicates itself to providing quality health services that meet the needs of its communities. Ranked #1 in the Columbia metro area by U.S. News & World Report, Lexington Medical Center is the only hospital named one of the Best Places to Work in South Carolina and the first hospital in the state to achieve Magnet with Distinction status for excellence in nursing care.

The 607-bed teaching hospital anchors a health care network that includes six community medical centers and employs more than 8,700 health care professionals. The network includes a cardiovascular program recognized by the American College of Cardiology as South Carolina’s first HeartCARE CenterTM and an accredited Cancer Center of Excellence affiliated with MUSC Hollings Cancer Center for research and education. The network also features an occupational health center, the largest skilled nursing facility in the Carolinas, an Alzheimer’s care center and nearly 80 physician practices.  Its postgraduate medical education programs include family medicine and transitional year.

 

 

 

 

Job Summary

Assist management in Insurance Services with all aspects of the daily administration of the self-insured Workers’ Compensation program.  Must be able to take appropriate measures to ensure compliance with timely bill payment, restrictions, and days away entry and OSHA reporting.  Works with medical providers to ensure timely scheduling and proper treatment of all workers’ compensation claims.  Interfaces with those involved with the claim (i.e. manager, injured employee, medical provider, TPA adjuster, safety) as needed.

Monitors activities ensuring efficiency in accordance with applicable laws and regulations. Maintains a thorough knowledge of Federal, State and Local law pertaining to areas of responsibility.  Completes all reporting relating to workers’ compensation and OSHA notification requirements, as needed.

Minimum Qualifications

Minimum Education: Bachelor’s Degree from an accredited college or university with major course in public administration, risk management, workers’ compensation or closely related field.
Minimum Years of Experience: 5 years of increasingly responsible professional and administrative experience in Workers’ Compensation.
Substitutable Education & Experience (Optional): A Bachelor's Degree may be offset with an Associate's Degree or Paralegal certificate and 5 years of additional commensurate experience in workers’ compensation claims management or High School Diploma or Equivalent and 15+ years of workers' compensation claims handling experience in an adjuster role.
Required Certifications/Licensure: None.
Required Training: Excellent interpersonal skills.

Knowledge of business office operations and administrative clerical operations. 

Ability to communicate effectively both orally and in writing with employees and managers, to maintain confidentially in daily operations, to conduct daily duties in a professional appearance and manner.

Advanced knowledge, ability, and working experience in Microsoft Word, Excel, and PowerPoint. Knowledge, ability, and experience in PeopleSoft is a plus.  

General knowledge of Insurance RMIS system is a plus.

Basic knowledge of SC Workers’ Compensation law, OSHA recording requirements, and claims management preferred.

Must be able to use file systems and clearly communicate via telephone, in person and through written and electronic media

Essential Functions

• Maintains entry of time away from work and/or light duty dates.  
• Communicates with Third Party Administrator (TPA) regarding claims and providing information as needed.
• Communicates with defense counsel and staff and providing information as needed.
• Submits claims to TPA through electronic form, as instructed.  
• Sends medical records to defense counsel, medical providers and TPA as needed.
• Work with Leave department to ensure all FMLA time for employees out of work and employees on transitional duty.
• Assists with all medical bills and forwards to the Accounts Payable Department and/or TPA, as appropriate.
• Provides monthly financial report to the Accounting Department, as needed.
• Coordinates referrals to medical providers, as needed. 
• Assist with gathering information from departments for our excess insurance application.
• Updates RMIS system with updated notes and/or incoming documents on each claim.
• Assists in maintaining OSHA 300 log (based on time away/restrictions)

Duties & Responsibilities

• Provides data for regulatory