Workers' Compensation Claims Specialist

4 weeks ago

Tampa, United States Fourth Enterprises, LLC Full time

The Workers' Compensation Claims Specialist is responsible for managing and processing claims related to workplace injuries or illnesses for a nationwide Professional Employer Organization (PEO). The Claims Specialist works with employers, employees, medical providers, and insurance carriers' Adjusters to ensure that the claims are handled in a timely & appropriate manner and effectively communicates the benefits of return-to-work programs to employers for lost time claims. The claims Specialist performs investigations, analysis of complex or disputed claims and works with outside counsel on settlements for litigated claims.

Additional duties include coordination of medical treatment and referrals, completion of claims documentation including wage statements, generation of medical panels, issuing certificates of insurance, preparation for claims reviews with detailed status updates and strategic action plans.

Works closely with Senior Management to ensure claims are handled in an appropriate and consistent manner with quality claims management in accordance with state WC claims laws, fair, and ethical practices. The Claims Specialist is responsible for the prompt and efficient examination, investigation and settlement or declination of claims through effective research, negotiation and interaction with Adjusters, insureds, brokers and outside counsel, ensuring that company resources are utilized in a cost-effective manner in the process.

The Role. . .

    • Promptly review and evaluate workers' compensation incident reports from the intake vendor to provide carrier Adjusters with pertinent information to determine claims eligibility, coverage, and benefits.
    • Initiate and provide excellent communication with claimants, employers, medical providers, and insurance carriers to obtain relevant information, documentation, investigation, and analysis to make a compensability determination, recommend a course of action, authorize payment, or denials accordingly.
    • Consistently question and probe all aspects of claims professionally and proactively with a customer-centric approach to achieve full understanding of facts and investigate potential fraud indicators in collaboration with Adjusters, Senior Management, and brokers.
    • Coordinate medical treatment and referrals for claimants and monitor their recovery and return to work status.
    • Accurate completion of 13-week wage statements for lost time claims to administer the delivery of accurate indemnity payments.
    • Effectively communicate the benefits of return-to-work programs and provide resources to employers with a high-level of customer service that promotes injured worker advocacy-based principles to maximize return-to work motivation and improve outcomes for all parties.
    • Recognize and investigate subrogation opportunities for recovery of third-party funds.
    • Build rapport with policyholders to educate them on claims reporting procedures, policies, and claim practices to include accountability while managing service expectations.
    • Investigate and resolve any issues or disputes that arise during the claim process.
    • Negotiate and settle claims within the authority limits and policy guidelines.
    • Prepare and maintain accurate and complete records and reports of claims activities.
    • Prepare and participate in internal claims reviews and stewardship meetings with large policyholders while applying knowledge of compliance policies and applicable laws.
    • Works collaboratively with Senior Management to manage service & intake vendors to achieve appropriate balance between allocated expense and loss outcomes.
    • Process post-accident drug tests for payment and trigger activity in case of positive drug test.
    • Generate Medical Panels for employer worksites in accordance with state statutes.
    • Issue Certificates of Insurance for Workers' Compensation in a timely manner with complete and correct information.
    • Occasionally prepare and coordinate special documents such as OSHA logs.
    • Comply with all federal, state, and local laws and regulations related to workers' compensation.
    • Stay updated on the latest trends and developments in the workers' compensation field.
    • Preparation of renewal documents, notifications, and labels.
    • Recommend process improvements where applicable to improve department efficiency, work product, and service commitment to stakeholders.
    • Additional responsibilities include completion of tasks/projects assigned by management.
The Ideal Candidate. . .
    • Bachelor's degree and/or five or more years of experience in an insurance related industry.
    • Must have a 6-20 Certified Adjuster License.
    • Minimum of five years of experience in workers' compensation claims handling.
    • Maintains a working knowledge of jurisdictional requirements and applicable case law for each state serviced.
    • Strong knowledge of insurance/medical terminology related to workers' compensation.
    • Proven critical thinking skills that demonstrate analysis/judgement and sound decision making with focus on attention to details.
    • Excellent communication (verbal and written), interpersonal, and customer service skills gained through previous work experience.
    • Basic knowledge of NCCI workers' compensation classifications
    • Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously. Balances teamwork and individual responsibilities.
    • Proficiency in Microsoft Office and claims management software.

  • Florida Workers' Compensation Claims Specialist

    8 hours ago

    Tampa, United States CorVel Corporation Full time

    The Claims Specialist manages within company standards and best practices complex and problematic, high visibility workers' compensation claims within delegated limited authority to determine benefits due; work closely with case managers and attorneys; manage subrogation and negotiate settlements to ensure specific customer service requirement to achieve...

  • Workers Compensation Claims Examiner

    4 weeks ago

    Tampa, United States Packard Claims Administration Full time

    Job DescriptionJob DescriptionPackard Claims Administration is a fast paced and growing TPA looking for a Workers Compensation Claims Examiner to join our team. We pride ourselves on having a family oriented environment that makes for an enjoyable place to work.Responsibilities:Must have and maintain a FL adjusters license (620 Florida All lines Adjusting...

  • Senior Claims Specialist

    1 week ago

    Tampa, United States Freelance Recruiters Full time

    Our client, based out of Tampa, FL, serves as a dedicated strategic partner to government and other agencies and is seeking a Sr. Specialist, Claims, who will be responsible for managing workers' compensation claims activity from conception to resolution. This is a fully remote role, with a salary range of $60-80k. Requirements Candidates must have: ...

  • Senior Claims Specialist

    2 weeks ago

    Tampa, United States Freelance Recruiters Full time

    Our client, based out of Tampa, FL, serves as a dedicated strategic partner to government and other agencies and is seeking a Sr. Specialist, Claims, who will be responsible for managing workers’ compensation claims activity from conception to resolution.This is a fully remote role, with a salary range of $60-80k.RequirementsCandidates must have:...

  • Medical Only Adjuster

    4 weeks ago

    Tampa, United States CorVel Full time

    ** Medical Only Adjuster (Claim Specialist)** **Job Category****:** Enterprise Comp (Claims) **Requisition Number****:** MEDIC04030 Showing 1 location **Job Details** **Description** CorVel is seeking a full time Medical Only Claims Specialist. The Medical Only Claims Specialist manages non-complex and non-problematic, medical only claims and minor lost-time...

  • Workers' Compensation Attorney

    1 month ago

    Tampa, United States Chris Ligori & Associates Full time

    Job Opportunity: Workers' Compensation Attorney at AV Rated Law FirmChris Ligori & Associate is actively seeking a skilled and dedicated Workers' Compensation Attorney to join our AV Rated Law Firm. If you are passionate about advocating for the rights of injured workers and possess the required qualifications, we invite you to apply.Key Requirements:Legal...

  • Workers' Compensation Attorney

    4 weeks ago

    Tampa, United States Chris Ligori & Associates Full time

    Job Opportunity: Workers' Compensation Attorney at AV Rated Law FirmChris Ligori & Associate is actively seeking a skilled and dedicated Workers' Compensation Attorney to join our AV Rated Law Firm. If you are passionate about advocating for the rights of injured workers and possess the required qualifications, we invite you to apply.Key Requirements:Legal...

  • Workers' Compensation Attorney

    6 days ago

    Tampa, United States Christopher Ligori & Associates Full time

    Job Opportunity: Workers' Compensation Attorney at AV Rated Law FirmChris Ligori & Associate is actively seeking a skilled and dedicated Workers' Compensation Attorney to join our AV Rated Law Firm. If you are passionate about advocating for the rights of injured workers and possess the required qualifications, we invite you to apply.Key Requirements:Legal...

  • Associate Attorney Social Security Disability/Workers Compensation

    1 day ago

    Tampa, United States Denovo Review Full time

    Job DescriptionJob DescriptionTop rated plaintiff personal injury firm based in Tampa, FL providing the highest quality legal services inside and out of the courtroom is seeking a Social Security Disability/Workers' Compensation Attorney to join their team. Associates will have the opportunity to work the practice of Auto Litigation as well, training...

  • Claims Resolution Specialist 2

    2 weeks ago

    Tampa, United States Tampa General Hospital Full time

    Responsible for prompt and accurate follow-up of all unpaid claims. Reviews assigned accounts to determine appropriate action needed with regards to claim resolution. Handles large payer projects as assigned by Department Manager. Responsible for 2nd Claims, Specialist, Healthcare

  • Commercial Claims Adjuster

    8 hours ago

    Tampa Palms, United States WAHVE Full time

    Put your Insurance Experience to work – FROM HOME! At WAHVE, we value significant insurance experience and want to revolutionize the way people think about phasing into retirement by offering qualified candidates the opportunity to continue their career working from home. As we say – retire from the office but not from work. Our unique platform provides...

  • Claims Resolution Specialist 1

    4 days ago

    Tampa, United States Tampa General Hospital Full time

    Responsible for prompt and accurate submission and follow-up of all third party claims. Reviews assigned accounts perform status inquiry and appeals to 3rd party payers to ensure reimbursement. Reviews assigned accounts, determines appropriate action Claims, Specialist, Healthcare

  • Senior Claims Specialist

    1 day ago

    Tampa, United States CRC Group Full time

    The position is described below. If you want to apply, click the Apply button at the top or bottom of this page. You'll be required to create an account or sign in to an existing one. Need Help? If you have a disability and need assistance with the application, you can request a reasonable accommodation. Send an email to Accessibility (accommodation requests...

  • Claims Adjuster

    1 month ago

    Tampa, United States Insurance Placement Solutions Full time

    Insurance Placement Solutions has an immediate opening for a Remote Construction Defect Claims Adjuster with our client. As a member of our client's claims team, utilize your knowledge of construction defect to independently investigate, evaluate, and resolve assigned claims in order to achieve appropriate outcomes. In this position, you will administer...

  • Claims Examiner

    4 weeks ago

    Tampa, United States Homeowners Choice Property & Casualty Insurance Company Full time

    Job DescriptionJob DescriptionJOB SUMMARYThe Claims Examiner – Inside Desk Adjuster has direct responsibility for homeowners' property insurance claims, starting with contacting the insured upon the loss through claims resolution. The Claims Examiner provides world class customer service to our insurance policyholders by empathetically handling each...

  • Claims Adjuster

    1 month ago

    Tampa, Florida, United States Insurance Placement Solutions Full time

    Insurance Placement Solutions has an immediate opening for a Remote Construction Defect Claims Adjuster with our client. As a member of our client's claims team, utilize your knowledge of construction defect to independently investigate, evaluate, and resolve assigned claims in order to achieve appropriate outcomes. In this position, you will administer and...

  • Claims Adjuster

    1 month ago

    Tampa, United States Insurance Placement Solutions Full time

    Insurance Placement Solutions has an immediate opening for an Auto Warranty Claims Adjuster with our client. As a member of our client's claims team, utilize your knowledge of auto warranty to independently investigate, evaluate, and resolve assigned claims in order to achieve appropriate outcomes. In this position, you will administer and resolve claims...

  • Poll Worker Support Specialist

    3 weeks ago

    Tampa, United States StaffEx Full time

    StaffEx is looking for a Poll Worker Support Specialist for the Hillsborough County Supervisor of ElectionsDepartment Name: Poll Worker Services and Training Position Title: Poll Worker Support Specialist Pay Rate: $17/Hr. Assigned Work Location: ESC Hours: Standard 8:00am – 5:00pm with the availability to work earlier, later and weekends  Job...

  • Revenue Cycle Specialist- Surgical Claims

    21 minutes ago

    Tampa, United States NSN Revenue Resources Full time

    Job Type Full-time Description Company Overview: At NSN Revenue Resources, a part of USPI (United Surgical Partners International), we are the largest Ambulatory Surgery Center network in the United States. We foster a culture of innovation, collaboration, and excellence. Our Central Billing Office plays a crucial role in supporting our extensive network of...

  • Revenue Cycle Specialist

    6 days ago

    Tampa, United States Bluestone Physician Services Full time

    Job DescriptionJob DescriptionBluestone Physician Services’ unique, robust model of care goes beyond primary care services. Our model is tailored to patients living with multiple chronic conditions and disabilities. Bluestone recognizes that patients need a customized approach to care that is preventative, proactive and includes all members of the care...