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Medical Adjuster

Role overview

Summary

This role supports the workers’ compensation claims process at Mercy, acting as a gatekeeper to ensure compliance with state regulations. You will work closely with injured co-workers, leaders, and medical providers to facilitate timely claims handling and resolution.

Qualifications

  • High School Diploma.
  • 3 years prior insurance or workers' compensation claims handling.
  • Ability to professionally communicate both verbally and in writing.
  • Ability to work independently making decisions in compliance with state and federal laws and Mercy's policies/best practices.
  • Preferred: Licensure in states where Mercy operates.

Responsibilities

  • Provide assistance to WC Coordinators by answering questions and requesting more information to determine compensability of claims.
  • Handle medical only claims and collaborate with Mercy Adjusters on lost time and litigated claims.
  • Conduct claim investigations, medical coordination, and documentation.
  • Review payments and ensure claims are processed timely in accordance with state requirements.

Key facts

Hard skills

Other skills

  • Communication
  • Decision Making

About the company

Mercy logo

Mercy

  • Hospitals & Health Systems
  • XLarge
  • 10,001+
Mercy, one of the 25 largest U.S. health systems, serves millions annually with nationally recognized quality care and one of the nation’s largest Accountable Care Organizations. Mercy is a highly integrated, multi-state health care system including more than 40 acute care, managed and specialty (heart, children’s, orthopedic and rehab) hospitals, convenient and urgent care locations, imaging centers and pharmacies. Mercy has 900 physician practices and outpatient facilities, 3,400 Mercy Clinic physicians and advanced practitioners, as well as more than 40,000 co-workers serving patients and families across Arkansas, Kansas, Missouri and Oklahoma. Mercy also has clinics, outpatient services and outreach ministries in Arkansas, Louisiana, Mississippi and Texas.Mercy’s Virtual Care Center is the world’s first such facility dedicated to care outside its own walls, monitoring patients 24/7/365 across the country, using high-speed data and video connections and medically intervening when and where patients need it with a comprehensive team approach. Visit MercyVirtual.netMercy was among the first health care organizations in the U.S. to have an integrated electronic health record (EHR) connecting all points of care. Mercy Technology Services’ broad use of its EHR has been recognized at one of the highest possible levels by Epic. Visit MercyTechnology.net.For information about Mercy's social media policy, please visit https://www.mercy.net/footer/website-terms-and-privacy/#social. Please note: many of the images and videos featured on our page were taken before the COVID-19 pandemic. Rest assured, we are following all necessary guidelines at this time, whether it's in photos and videos here, or in person at any of our Mercy facilities. For more information, visit Mercy.net/COVID19.

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Job description

Find your calling at Mercy!

The purpose of this position is to provide assistance to WC Coordinators by answering questions and requesting more information when needed to determine compensability of a claim. As the 'gatekeeper' for the WC program, this position is essential in ensuring Mercy is consistent with application of state(s)regulations and claims handling across the Mercy System. Handling medical only claims and working as a team member with the Mercy Adjusters who handle lost time and litigated claims.

Position Details:

This is a REMOTE Full-Time position


This role supports workers’ compensation claims from initial reporting through resolution, partnering with injured co-workers, leaders, medical providers, and the Workers’ Compensation team. Responsibilities include claim investigation, medical coordination, documentation, payment review, and ensuring claims are handled timely and in accordance with state requirements.


MINIMUM QUALIFICATIONS:

Education: High School Diploma

Experience: 3 years prior insurance or workers' compensation claims handling

Other:

- The ability to professionally communicate both verbally and in writing.

- Must be able to work independently making decisions in compliance with state and federal laws and Mercy's policies/best practices.


PREFERRED QUALIFICATIONS:

Licensure: Licensure in states where Mercy operates

Preferred Experience:

- A background in insurance and claims

- Basic knowledge of workers' compensation structure and specific knowledge of MO, AR, OK and KS WC regulations knowledge of OSHA, Legal, and medical terminology.

- Background in the medical field

Why Mercy?

From day one, Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period.

Join a caring, collaborative team where your voice matters. At Mercy, you'll help shape the future of healthcare through innovation, technology, and compassion. As we grow, you'll grow with us.

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