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Workers' Compensation Claims Examiner
2 months ago
We are seeking a highly skilled Workers' Compensation Specialist to join our team at the City of Jacksonville, FL. As a key member of our Finance Department, you will be responsible for monitoring, reviewing, and processing workers' compensation claims.
Key Responsibilities:- Monitor and review workers' compensation claims to ensure compliance with laws, rules, and regulations.
- Process claims, including reviewing medical bills and other services for reasonableness and conformity to the appropriate medical and surgical fee schedule.
- Respond to audits and manage field investigations of workers' compensation claims.
- Authorize and prepare payments of approved claims.
- Identify and recommend claims for subrogation and excess insurance carrier claims reporting.
- Calculate and recommend workers' compensation case reserves for the Self-Insurance Fund.
- Oversee and monitor rehabilitation of claimants for compliance with workers' compensation laws, rules, and regulations.
- Compile data for and prepare written reports and oral presentations.
- Establish and maintain workers' compensation claim files and records.
- Respond to inquiries regarding workers' compensation claims and related issues.
- Provide technical assistance to medical providers, lawyers, government agencies, and the general public.
- Three (3) years of education, and/or experience in Workers' Compensation, General Liability, automobile liability or claims monitoring, reviewing and processing.
- Florida All Lines Claims Adjuster License is required prior to appointment and must be maintained during employment in this class.
The City of Jacksonville provides a wide array of benefits to meet the diverse needs of our employees. Our comprehensive benefit programs include medical, dental and vision plans; life insurance coverage for you and your dependents; flexible spending plans for medical reimbursement, dependent care, parking, and transit expenses; an employee assistance program for you and your dependents; a 457(b) tax-deferred compensation plan to supplement your retirement, and a ROTH IRA plan. We also provide an extensive wellness program that includes a health intervention program if qualified, lunch and learns, health fairs, and discounted gym memberships.
