Workers’ Compensation Medical-Only Claims Adjuster | CO & AZ experience

Insurance Placement Solutions (IPS) has an immediate opening for a Workers’ Compensation Medical-Only Claims Adjuster with our client. This is a fully remote opportunity for a claims professional with experience handling Colorado and Arizona workers’ compensation claims. Candidates must have at least two years of claims management experience or an equivalent combination of education and experience, with knowledge of medical-only claims handling, compensability, and medical benefit administration.

In this role, you’ll manage workers’ compensation medical-only claims involving Colorado and Arizona jurisdictions, from initial investigation through resolution. You’ll determine compensability, coordinate medical treatment, review medical benefits, monitor reserves, and communicate with injured workers, employers, and medical providers while ensuring accurate claim documentation and compliance with applicable state regulations and client requirements.

Workers’ Compensation Medical Only Claims Adjuster Responsibilities

• Manage workers’ compensation medical-only claims involving Colorado and Arizona jurisdictions
• Investigate claims and determine compensability in accordance with applicable state regulations
• Evaluate medical documentation and determine appropriate medical benefit eligibility
• Coordinate medical treatment and monitor claim developments through resolution
• Review and process medical bills and authorize claim payments within designated authority
• Establish and monitor claim reserves to ensure appropriate financial exposure
• Develop claim action plans to support timely and cost-effective resolution
• Review medical treatment recommendations and utilization review determinations when applicable
• Identify potential subrogation opportunities and pursue appropriate recovery actions
• Complete required state filings and maintain accurate claim coding and documentation
• Communicate claim status and developments with injured workers, employers, medical providers, and clients
• Monitor claims for changes in medical condition or exposure that may require escalation
• Maintain accurate diary management and meet regulatory and client service deadlines
• Ensure compliance with company claims-handling standards and applicable workers’ compensation regulations

Qualifications

• Experience handling Colorado and Arizona workers’ compensation claims
• Minimum of 2 years of claims management experience, an equivalent combination of education and experience, or successful completion of a Claims Representative training program
• Knowledge of workers’ compensation medical-only claims handling and medical benefit administration
• Understanding of compensability determinations, medical treatment coordination, and claims reserving
• Familiarity with applicable state workers’ compensation regulations and medical management practices
• Strong analytical, organizational, and problem-solving skills
• Excellent written and verbal communication skills
• Ability to independently manage an assigned caseload and meet established deadlines
• Proficiency with Microsoft Office applications and general claims management systems

About Insurance Placement Solutions

Insurance Placement Solutions is a staffing and recruiting firm specializing in the insurance industry. We connect talented professionals with temporary, temp-to-hire, and direct-hire opportunities at leading insurance organizations across the United States.

ID: 006Uw00000gB0ao