WORKERS' COMPENSATION SPECIALIST - 43003070

State of Florida

21h•Onsite

About The Position

The Workers’ Compensation Specialist under limited supervision performs specialized investigations, examining and analyzing the case management system in the Permanent Total Section of the Monitoring and Audit Bureau. Workers’ Compensation Specialist responsibilities include authorizing and calculating permanent total disability benefits to eligible injured workers, which are paid from the W.C. Administration Trust Fund. The Workers’ Compensation Specialist is also responsible for determining and applying various factors involving the amount of benefits due to injured workers: such as offsetting social security payment, joint petitions stipulation settlements and other judicial orders. The Workers’ Compensation Specialist is responsible for educating, training and answering inquiries regarding PT benefits. The Workers’ Compensation Specialist also seeks to resolve disputes and help reduce litigation. This position is responsible for conducting on-site field audits, desk audits and re-audits of insurers. The Workers’ Compensation Specialist uses independent judgment in the interpretation, application and enforcement of Florida Workers’ Compensation Laws, Division rules, policies and procedures.

Requirements

Four (4) years of experience in a relevant field (risk management, insurance, claims handling, medical billing and reporting, financial accounting, or auditing)
Knowledge of the principles and techniques of effective verbal and written communication.
Ability to perform basic mathematical computations.
Ability to handle telephone calls in a fast, courteous and effective manner.
Ability to work independently.
Ability to utilize problem-solving techniques.
Ability to conduct fact-finding investigations.
Ability to plan, organize and coordinate work assignments.
Ability to communicate effectively.
Ability to establish and maintain effective working relationships with others.
Ability to prepare and maintain records relating to a workers' compensation program.
Ability to negotiate and facilitate resolution agreements.

Nice To Haves

One (1) or more years of experience in workers’ compensation.
One (1) or more years of professional experience in claims handling, medical billing, or insurance.
Two (2) or more years of experience using Microsoft Word.
Two (2) or more years of experience using Microsoft Excel.

Responsibilities

Examine and monitor cases to prevent or rectify overpayment or fraudulent receipt of payments.
Investigates permanent total cases for possible fraud or overpayment.
Reports fraudulent cases to the concerned authorities for action.
Investigate workers’ compensation claims when a request for permanent total supplemental benefits is made.
Determines, calculates and authorizes PT payments.
Applies social security offset against benefits whenever applicable in accordance with appropriate statutes and case law.
Provides assistance and answers questions relating to the Workers’ Compensation Law and claims handling procedures, from attorneys, insurance company representatives, employers, employees and health care providers via the toll-free lines and regular telephone lines.
Prepares case records and handles all follow up activities pertaining to recoupment of overpayment.
Appears for depositions and testifies at hearings as a part of the examining and monitoring function.
Assists injured workers in applying for social security disability benefits from social security administration, in accordance with Florida Workers’ Compensation Statutes.
Contacts injured workers to obtain Employee Earning Reports (DWC-19) on an annual basis.
Resolves disputes to avoid litigation between injured workers, employers and attorneys.
Attend hearings and depositions when required.
Review Permanent Total files for annuity payments, joint petition and stipulation settlements, lump-sum advance payments, carrier election changeovers, unemployment compensation, social security benefits and Permanent Total closed cases.
Verifies proper receipt of supplemental payments through listing of checks held, initial supplemental payments, signature comparisons, address changes and other documents.
Reviews vital statistics reports social security advisories, carrier reports, Notice of Action/Change (DWC-4’s) and correspondence in order to timely terminate benefits to ineligible claimants.
Prepare summary reports of opinions and recommendations submitted by Division staff and other consultants.
Investigates final orders of Deputy Commissioners, District Court of Appeals and State Supreme Court and takes action to assure employer/carriers compliance with the Order and/or refer to Office of the General Counsel for clarification and opinion.
Conducts on-site field audits, desk audits, and re-audits of insurers to ensure proper carrier practices relating to workers’ compensation claims handling procedures.
Confers with company personnel and officials regarding practices or possible violations of the Workers’ Compensation Law and determines penalties as required.
Audits information obtained from thorough examination of Division and company field office case files and compiles statistical data to determine compliance with Division rules.
Compiles a formal report producing audit findings for distribution to appropriate parties upon completion of an audit.
Responsible, if applicable, for recommendation of revocation and/or suspension of an insurer’s license to conduct business in the State of Florida.
Coordinates with the Special Disability Trust Fund - Fiscal Section on payment and/or suspension of supplemental benefits, address changes and guardianship orders.
Corresponds with Social Security Administration on disability benefits information and dual social security number verifications.
Requests and utilizes rehabilitation evaluations and prepares background information on trial work referrals.
Prepares background information on P.T. cases requiring review by department attorneys and utilizes case law updates and legal advisory opinions in determining proper handling of cases.
Prepares background information on cases to be referred to the Bureau of Fraud.
Prepares background information on cases to be referred to the Department.
Review orders of Judges of Compensation Claims, First District Court of Appeals and Florida Supreme Court to determine proper handling of P.T. cases.
Monitors, examines, and inputs data in the Divisions’ data base system.
Verifies for accuracy of information
Conducts training sessions performs other duties as required