Workers' Compensation Medical Claims Adjuster

Publix•Lakeland, FL

1d•$52,000 - $71,760

About The Position

This position investigates work-related injuries reported by Publix associates involving fewer than eight days away from work. It analyzes the facts of each case against the statutory eligibility requirements of the applicable state’s workers’ compensation laws to determine whether the associate qualifies for benefits. For eligible claims, the adjuster provides benefits and manages the claim to conclusion in accordance with state law. Ineligible claims are denied, and the decision is communicated to associates and other stakeholders. The role also manages claim activity until the associate is discharged from further medical care. If a medical-only claim results in more than seven days of lost time or the associate obtains legal representation, the adjuster prepares the claim for hand-off to a Lost Time Adjuster and makes the first lost-wage indemnity payment. The adjuster identifies claims that may create increased exposure or require 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.
Initiative.
Planning and organizing skills.
Self-development.
Stress tolerance.
Arithmetic computation.
Attention to detail.
Relationship-building skills.
Customer focus.
Active listening.
Verbal communication skills.
Written communication skills.
Interviewing skills.
Investigative skills.
Microsoft Word skills.
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.
Currently hold a 6-20 General Lines Adjuster license.
Knowledge of medical terminology, procedures, and pricing.
Knowledge of the workers’ compensation laws of each state where Publix operates.
Knowledge of workers’ compensation regulatory requirements in each state where Publix operates.
Knowledge of Publix’s Return-to-Work, Leaves, FMLA, and HIPAA policies.
Microsoft PowerPoint skills.
Microsoft Access skills.
Assure Claims.

Responsibilities

Investigate reported work-related injuries and analyze gathered facts to determine eligibility for workers’ compensation benefits.
Exercise independent judgment to determine the scope and method of an investigation and interpret its findings under the applicable state workers’ compensation laws and eligibility requirements.
Provide benefits and manage eligible claims through conclusion in accordance with state law; 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 claims for hand-off 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 cause increased exposure or require supervisory notification.

Benefits

Holiday bonus paid in November: 15 hours of pay in the first year of continuous employment, one week’s pay in the second year if still employed on the issue date, and two weeks’ pay in subsequent years.
Employee stock ownership plan that contributes Publix stock to associates each year at no cost.
Opportunity to purchase additional shares of privately held Publix stock.
401(k) retirement savings plan.
Group health, dental, and vision plans.
Paid time off.
Paid parental leave.
Short- and long-term disability insurance.
Tuition reimbursement.
Free hot buffet-style lunches at facilities with a cafeteria.