Job Description
- Job Description:
- Investigate and evaluate Florida workers’ compensation claims to determine compensability, exposure, and total claim value in accordance with Florida statutes and case law.
- Establish and maintain appropriate reserves using reserving tools, ODG guidelines, and company reserving philosophy.
- Initiate and manage indemnity payments and maintain diary systems for ongoing payments and claim activity.
- Complete state-required filings and EDI reporting accurately and within required timelines.
- Assign and coordinate with defense counsel on litigated claims and assist with litigation strategy.
- Collaborate with Nurse Case Managers to monitor medical treatment and authorize appropriate medical services under Florida Statute 440.13.
- Review and approve medical bills within required timeframes.
- Determine need for vocational rehabilitation services to assist injured employees with return-to-work planning.
- Coordinate light duty opportunities and workplace accommodations with employers and medical providers.
- Maintain consistent communication with clients and attend client meetings as required.
- Maintain accurate documentation, diaries, and workflow management to ensure regulatory compliance.
- Identify potential subrogation or recovery opportunities and pursue appropriate reimbursement from responsible parties.
- Protect Medicare’s interests and ensure compliance with MMSEA Section 111 reporting requirements.
- Monitor claims for red flags or potential fraud indicators.
- Request reimbursement from excess carriers as required and follow up on outstanding recoveries.
- Escalate client concerns or E&O risks to leadership when appropriate.
- Maintain performance expectations, including a 97% claim closure ratio.
- Requirements:
- Workers’ compensation claims handling experience, including lost time and litigated claims
- Active Florida All-Lines Adjuster License or Florida Workers’ Compensation License
- Experience evaluating claims, setting reserves, and managing litigation files
- Strong knowledge of Florida Workers’ Compensation statutes and rules
- Experience coordinating with defense counsel and nurse case managers
- Proficiency with Microsoft Office Suite
- Excellent written and verbal communication skills
- Strong organization, prioritization, and time-management skills in a fast-paced environment
- Ability to work independently while collaborating with a team
- Experience handling multiple claim types or presumption claims
- Experience with depositions, mediations, and settlement negotiations
- Familiarity with systems such as IDatix, Workers Computation, ISO, or ShoreTel
- Benefits:
- Medical, dental, and vision plans to ensure your health and that of your family.
- A 401k plan with employer matching to help you build a secure financial future.
- Our time-off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) package for non-exempt employees, reflect our commitment to promoting a healthy work environment.
- Paid holidays.
- Life insurance and both short-term and long-term disability plans, providing essential financial protection for you and your loved ones.
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