This position reports directly to the Risk Manager and is responsible for daily administration, operation, and supervision of the worker’s compensation claims staff. Ensure utilization and compliance with best claims practices & procedures and state statutes.
( NOTE: These are intended only as illustrations of the various types of work performed. The omission of specific duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position .) Duties may vary depending on assignment. Claims Management
Daily administration, operation, and supervision of the workers’ compensation activity.
Establishes claim reserving practices to ensure claims are adequately reserved. Performs periodic claims audits.
Coordinates and pursues all excess workers’ compensation claims with the various excess carriers.
Supervises and manages worker’s compensation claims staff including, but not limited to: assigning, evaluating, reviewing, and providing direction on workers’ compensation claims to adjusters.
Reviews decisions regarding claims handling of workers’ compensation claims staff, utilizing knowledge of best claims practices and procedures.
Ensures that Risk Management meets all State of Florida Workers’ Compensation claims reporting including all Electronic Data Interchange (EDI) mandates.
Works with the Counsel to provide input and direction on claims in litigation.
Monitors program services and customer services to record and implement process and service improvements.
Reports key performance indicators within the self-insured program to the Risk Manager.
Works with Risk Manager to develop and implement policies and procedures for claims handling, pursuant to Best Claims Practices.
Bachelor’s degree in Public Administration, Business Administration, Social Science or related field, and five (5) years progressively responsible experience in area of assignment (eg. benefits, workers’ compensation, employee relations, employment, etc.). A comparable amount of education, training or experience may be substituted for the minimum qualifications. The preferred applicant should have at least five (5) years of experience as a worker’s compensation claims adjuster handling Florida lost-time worker’s compensation claims and three (3) years supervisory experience over adjusters handling lost-time worker’s compensation claims. The ideal applicant should also have/maintain the following Licenses/certifications: Florida Workers’ Compensation Adjuster’s License, Florida All Lines Adjuster License, Workers’ Compensation Claims Professional (WCCP), Certified Worker’s Compensation Litigation (CWCL).
Knowledge, Skills & Abilities:
Demonstrated knowledge of Florida Statute 440 Workers’ Compensation Law and all reporting requirements.
Demonstrated knowledge of all federal, state, and local regulatory requirements pertaining to Workers’ Compensation claims.
Skilled in investigative and adjustment techniques, procedures and practices involving Workers’ Compensation claims.
Demonstrated knowledge of medical terminology as required for reviewing diagnostic and treatment records/reports.
Demonstrated knowledge of HIPPA’s privacy and security requirements as they pertain to protected health care information.
Knowledge of automated claims administration systems. CERTIFICATE(s)/LICENSES: Must possess and maintain a valid Florida driver’s license. Claims Management Florida Workers’ Compensation Adjuster’s License or a Florida All Lines Adjuster License.
ADA REQUIREMENTS: Physical Demands: Sedentary work. Ability to talk. Environmental Demands: Inside work. Mental Demands: Ability to read and comprehend legal statutes and documents, professional and technical manuals and journals, reports, and financial statements. Ability to complete basic mathematical computations including addition, subtraction, multiplication, division, fractions, ratios. Ability to speak publicly and extemporaneously. Ability to write reports, letters, memos, and summaries. Ability to analyze data and develop conclusions. Ability to identify problems and resolve same. Ability to apply statutes and procedures to real situations.
Volusia County, FL - 14 months ago