Workers' Compensation Claims Examiner

7 days ago

Tallahassee, Florida, United States My Florida Corp Defunct Full time
Job Summary

This is a highly responsible and professional position in the investigation, evaluation, and payment of workers' compensation claims handled by the Division of Risk Management. The Workers' Compensation Specialist conducts detailed investigations of workers' compensation claims submitted to Risk Management on state employees, applies the appropriate laws, and makes a determination of compensability. The Specialist evaluates medical reports, authorizes medical treatment, determines if rehabilitation is needed, authorizes compensation payments and settlements. The Specialist must calculate and maintain proper monetary reserves on claims and must recognize and pursue recoveries either through subrogation or the Special Disability Trust Fund. The Specialist handles workers' compensation claims that have been assigned to defense counsel by directing defense activity to conform to sound claims handling principles. The Specialist attends formal workers' compensation mediations and hearings when necessary. The Specialist assists and advises the Claims Coordinators of various state agencies, departments, divisions, bureaus, and sections with questions concerning workers' compensation claims, including but not limited to, questions of coverage, compensability, medical treatment, and reporting work-related accidents. As needed, the Specialist monitors the activities of Risk Management's prior service companies and timely and accurately completes all DWC forms necessary for Electronic Data Interchange Reporting. The Specialist performs other related work as required.

Responsibilities

* Conduct detailed investigations of workers' compensation claims submitted to Risk Management on state employees

* Apply the appropriate laws and make a determination of compensability

* Evaluate medical reports and authorize medical treatment

* Determine if rehabilitation is needed and authorize compensation payments and settlements

* Calculate and maintain proper monetary reserves on claims

* Recognize and pursue recoveries either through subrogation or the Special Disability Trust Fund

* Handle workers' compensation claims that have been assigned to defense counsel

* Direct defense activity to conform to sound claims handling principles

* Attend formal workers' compensation mediations and hearings when necessary

* Assist and advise the Claims Coordinators of various state agencies, departments, divisions, bureaus, and sections with questions concerning workers' compensation claims

* Monitor the activities of Risk Management's prior service companies and timely and accurately complete all DWC forms necessary for Electronic Data Interchange Reporting

* Perform other related work as required

Requirements

This position requires a bachelor's degree from an accredited college or university and one or more years of experience in the insurance field or six months of experience adjusting workers' compensation claims. The ideal candidate will have a Florida Adjuster License and at least one year of experience adjusting workers' compensation claims within the last three years. The candidate should also have at least one year of experience working in workers' compensation insurance claims business and at least one year working in workers' compensation insurance claims business in the State of Florida. Experience working with any risk management information systems and/or any software programs designed to assist adjusting workers' compensation claims is also preferred.

Working Conditions

This is a highly responsible and professional position that requires the ability to work independently and exercise a great deal of independent judgment. The Specialist will work under the general supervision of the Workers' Compensation Administrator and will be responsible for conducting detailed investigations of workers' compensation claims submitted to Risk Management on state employees. The Specialist will also be responsible for applying the appropriate laws and making a determination of compensability. The Specialist will work in a fast-paced environment and will be required to handle multiple tasks and priorities simultaneously.

Benefits

This position offers a competitive salary range of $46,548.00-$50,000.00, based upon experience. The position also offers a comprehensive benefits package, including health, dental, and vision insurance, as well as a 401(k) plan. The position also offers paid time off and holidays.

How to Apply

To apply for this position, please submit your application and resume to the People First Service Center. Please note that responses to qualifying questions must be clearly supported by the state application and any omission, falsification, or misrepresentation in the answering of the qualifying questions will be cause for immediate elimination from the selection process.

Equal Employment Opportunity

The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer and does not tolerate discrimination or violence in the workplace. Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center.

Drug-Free Workplace

The State of Florida supports a Drug-Free workplace and all employees are subject to reasonable suspicion drug testing in accordance with Section , F.S., Drug-Free Workplace Act.

Veterans' Preference

Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans' Preference will receive preference in employment for Career Service vacancies and are encouraged to apply. Certain service members may be eligible to receive waivers for postsecondary educational requirements. Candidates claiming Veterans' Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code.

Location

Tallahassee, FL, US, 32308

Nearest Major Market
Tallahassee

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