Workers' Compensation Medical Claims Adjuster

Publix • Lakeland, FL

3d

About The Position

The Workers' Compensation Medical Claims Adjuster investigates work-related injuries reported by Publix associates involving fewer than eight days away from work. The role determines eligibility for workers' compensation benefits by analyzing the facts of each case against the applicable state’s statutory requirements. Once eligibility is confirmed, the adjuster provides benefits and manages the claim through conclusion in accordance with the relevant state laws. If a claim is not eligible, the adjuster denies it and communicates the decision to associates and other stakeholders.

The adjuster independently determines the appropriate scope and methods of investigation, evaluates gathered facts under the applicable state law, and manages claim activity until the associate is discharged from further medical care. The position also prepares a claim handoff to a Lost Time Adjuster and issues the first lost-wage indemnity payment if a medical-only claim results in more than seven days of lost time or the associate obtains legal representation. The role identifies claims with increased exposure and those requiring supervisory notification.

Requirements

• High school diploma.
• Six months of experience working in a claims environment or 12 months of Publix retail experience.
• Ability to obtain a 6-20 General Lines Adjuster license within six months of employment.
• Skills in initiative, planning and organizing, self-development, stress tolerance, arithmetic computation, detail orientation, relationship building, customer focus, active listening, verbal and written communication, interviewing, and investigation.
• Microsoft Word and Microsoft Excel skills.

Nice To Haves

• Bachelor’s degree in any discipline.
• One year of prior experience in a claims setting.
• Two years of Publix retail experience.
• Current 6-20 General Lines Adjuster license.
• Knowledge of medical terminology, procedures, and pricing.
• Knowledge of workers’ compensation laws in each state where Publix operates.
• Knowledge of workers’ compensation regulatory requirements in each state where Publix operates.
• Knowledge of Publix Return-to-Work, Leaves, FMLA, and HIPAA policies.
• Microsoft PowerPoint and Microsoft Access skills.
• Assure Claim experience.

Responsibilities

• Investigate work-related injuries reported by Publix associates involving fewer than eight days lost from work.
• Analyze investigation findings and determine whether an associate qualifies for workers’ compensation benefits under applicable state laws.
• Independently determine the scope and methods of investigation and interpret case facts in light of state-specific eligibility requirements.
• Provide benefits and manage eligible claims through conclusion in accordance with applicable state laws.
• Deny ineligible claims and communicate the determination to associates and other stakeholders.
• Manage overall claim activity until the associate is discharged from further medical care.
• Prepare claim files for handoff to a Lost Time Adjuster and make the first lost-wage indemnity payment when a medical-only claim results in more than seven days of lost time or the associate secures legal representation.
• Identify claims that may create increased exposure and claims requiring supervisory notification.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED