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Fervent Adjudicator diligently ensuring compliance with workers’ compensation eligibility and addressing hiring discrimination claims. Adept at evaluating claims and delivering a timely decision. Committed to applying knowledge of current laws and regulations to ensure fair efficient results.
● Substantial understanding of medical and workers’ compensation claims processes
● Familiar with current state and federal discrimination and disability regulations
● Strong familiarity with medical billing codes
● Solid knowledge of medical and basic legal terminology
● Proficient in the use of MS Word Access and PowerPoint
● Very good internal and external communications abilities
● Ability to work flexible shifts and overtime as necessary
● Strong time management and organizational skills
● Contacted claimants when additional information was required for applications.
● Established solid internal and external communications.
● Processed and verified all applications for adjudication.
● Confirmed that applications were correctly filled out.
● Handled paperwork for medical claims.
● Trained and supervised support staff.
● Verified patient insurance coverage.
● Prepared quarterly reports on all adjudicated matters as requested by Registrar
● Thoroughly checked all reports and facts and reported any inconsistencies
● Reviewed applicants’ cases and requested additional information as necessary
● Prepared analysis reports with recommendations for specific courses of action
● Stayed current on relevant laws regulations policies and precedent decisions.
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