Workers' Compensation Claims Examiner

13 hours ago


Jacksonville, Florida, United States City of Jacksonville, FL Full time
Job Title: Workers' Compensation Specialist

Job Summary: 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. Your expertise in workers' compensation laws, rules, and regulations will be essential in ensuring compliance and providing exceptional client services.

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.
Requirements:
  • 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.
Benefits:

The City of Jacksonville offers a comprehensive benefits package, including medical, dental, and vision plans, life insurance coverage, flexible spending plans, an employee assistance program, a 457(b) tax-deferred compensation plan, and a ROTH IRA plan. We also provide an extensive wellness program, including a health intervention program, lunch and learns, health fairs, and discounted gym memberships.

Please visit the Employee Benefits website for details on all the plans we offer.



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