Claim Adjuster

4 weeks ago

Fort Lauderdale, United States 4BBCorp Full time
Job DescriptionJob Description

We are seeking a Claim Adjuster to become a part of our organization You will perform advanced specialized technical work in the investigation and adjustment of public liability and/or Workers' Compensation claims.

Working under general supervision, independently developing work methods and sequences.

Responsibilities:

  • The functions listed below are those that represent the majority of the time spent working in this class. Management may assign additional functions related to the type of work of the job as necessary.
  •  Reviews and analyzes reports of accidents including property damage and bodily injury to determine liability; reviews and analyzes Liability and/or Workers' Compensation claims and recommends appropriate action.
  • Consults on injury cases with various medical personnel in order to ascertain the extent and cost of treatment, loss of earning capacity and prognosis; confers with County physician on employment limitations.
  • Performs the calculation and payment of benefits whether indemnity and/or medical benefits, including entering all payments for benefits.
  • Coordinates the gathering of formal evidence by taking photographs, preparing diagrams and making measurements at accident scene; arranges for witnesses to appear at legal proceedings; and prepares accident reports.
  • For Workers Compensation claims the adjuster will contact the injured employee, employer, and medical provider to document the claim. For Liability claims the adjuster will contact the claimant, the division and any witnesses.
  • Contacts injured employee, employer, and medical provider to document claim. Conducts field investigations, face-to-face statements with employees, employer representatives and witnesses to understand the nature of the claim and gain an understanding of what occurred prior to the claim.
  • Negotiate claim settlements with the Director of Risk Management, the County Administrator, the County Attorney, claimants and/or their legal teams. Attend mediations with the County Attorney’s office to support the claims process.
  • Provide advice regarding potential fraud, subrogation, and underwriting/safety risk, and communication with counsel.
  • Authorizes/coordinates medical treatment with walk-in facilities and specialists to update claim.
  • Make decisions for approvals of medical treatments and property restoration. Make determinations
    on liability or compensability for Workers Compensation claims. Apportion percentage of liability
    and negotiate settlement with claimant or claimant's attorney or Liability Claims.
  • Investigates liability claims, inputs data into the system association with findings.
  • Sets up medical only claims to document/update current work status and treatment.
  • Monitors/obtains discharge papers for impairment ratings and issues benefits when owed and paid within mandated timeframe to avoid penalties.
  • Monitors work status for a disability of 7 days or less through discharge for closing a claim.
  • Denies/processes claims for non-work-related injuries with timely electronic filing to avoid penalties.
  • For disability more than 8 days, initiates timely electronic filings to Division of Workers' Compensation
  • Attends meetings with other Divisions, Professional Standards/Human Rights Section (PS/HRS), and
    Human Resources to discuss complex claims.

Qualifications:

  • Requires two (2) years equivalent of higher-level education from an accredited college or university with major coursework in insurance, risk management, or closely related field.
  • (One year of relevant experience may be substituted for each year of required education.)
  • Requires four (4) years in adjusting workers' compensation and/or bodily injury/property damage liability
    claims or closely related experience.

SPECIAL CERTIFICATIONS AND LICENSES:

  • Possession/retention of a Florida All-Lines Adjuster’s License (Type 6-20 or 7-20) from the State of Florida
    Division of Insurance Agent and Agency Services.
  • Must possess and maintain a valid Florida Class E Driver's License for duration of appointment

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