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Claims Specialist

1 month ago

Melbourne, United States AppleOne Employment Services Full time

The Claims Specialist is responsible for ensuring timely processing of claims; evaluating accident reports to determine accuracy and completeness and ensuring adequate investigation. This position is also responsible for ensuring that the Company is in compliance with applicable laws and regulations and providing training and guidance, as needed.


Responsibilities:

· Monitor and record appropriate leave usage relative to Workers Compensation benefits; notify payroll and other appropriate personnel regarding adjustments

· Provide technical guidance and advice to supervisors, managers and site representatives regarding Workers Compensation, Auto Accidents and General Liability issues; serve as liaison between: return-to-work program, injured employees and managers in relation to returning injured employees back to work, repair shop and Fleet department for auto repairs, and provide documentation as necessary to adjusters and Defense counsel in law suits

· Analyze circumstances of claims, injury records and medical evaluations, accident videos and photos; document injuries; assure prompt delivery of medical and financial services

and the return of injured workers to safe and productive employment in a timely manner, timely repair of company vehicles

· Assist Risk Manager with facilitating and coordinating program-related training as appropriate; assist in providing training to departmental administrative personnel regarding roles in recording/reporting job-related injuries, damage to company vehicles and liability coverage

· Prepare and maintain a variety of records, logs, correspondence, and files related to assigned activities; maintain OSHA records

· Receive, file and organize employee accident reports; determine reportable accidents; initiate and process claims; maintain files and correspondence regarding employee accident reports; maintain communication with third party administrators; notify managers regarding employee accident reports, trends or preventative measures

· Coordinate and maintain schedules for ergonomic evaluations for employees with the ergonomic evaluator; assist the evaluator as requested; maintain related spreadsheets; submit and track work orders placed to the appropriate department for the installation of employee’s ergonomic supplies

· Receive and process information on property and liability claims; provide requesting parties appropriate documentation and forms regarding property and liability claims

· Receive billings and estimates; obtain appropriate signatures and submit to accounts payable for payment

· Evaluate accident reports, ensuring the timely processing of medical bills, temporary total disability benefits and deductible payments

· Review witness statements, department investigation results and other documentation and compiles facts and data regarding accident reports and filed cases

· Maintains subrogation records and files for those incidents involving third parties; send subrogation letters to third parties in an effort to obtain reimbursement of monies spent by the Company for medical treatment, time loss, and awards and settlements paid; submits amounts paid for medical treatment and/or temporary total disability benefits to the State Attorney's Office in order to seek reimbursement in cases where criminal charges have been filed

· Reviews documentation to determine whether medical bills and temporary total disability benefits should be continued; authorizes payment of medical bills and temporary total disability benefits and deductible payments upon receipt of proper documentation

· Other related duties, as assigned


Qualifications:


Required Knowledge, Skills, and Abilities:

· Excellent organization and time management skills to handle multiple tasks in an environment with large volumes of data and paperwork

· Excellent verbal and written communication skills

· Excellent customer service skills, both orally and in writing

· High degree of accuracy and exceptional attention to detail

· Proven time management skills with a proven ability to meet deadlines

· Ability to interpret, apply and explain Workers Compensation coverage and benefits to employees

· Ability to maintain confidentiality with sensitive data

· Ability to function well in a fast-paced and demanding environment

· Ability to establish and maintain comprehensive records and prepare reports

· Ability to interpret, apply and explain applicable laws, codes, rules and regulations

· Ability to analyze facts, information, and data

· Ability to establish and maintain cooperative and effective working relationships with others

· Ability to appropriately prioritize tasks and to meet schedules and timelines (time management)

· Ability to execute tasks independently


Education and Experience:

· High school diploma or equivalent required, college degree preferred

· Prior onboarding Workers’ Compensation & Vehicle Repair required

· Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)

· Smartsheets or other EHS platforms

· Detailed oriented, Troubleshooting, Problem solving, Work independently, Time management, good Communication skills

· Prior work with TPA’s and Liability Insurance carriers

· HVAC Industry experience or service industry a plus