WORKERS' COMPENSATION SPECIALIST - 43001997
About The Position
The Workers' Compensation Specialist is a highly responsible professional role in the investigation, evaluation, and payment of workers' compensation claims handled by the Division of Risk Management. The position works under the general supervision of the Compensation & Benefits Manager I, exercises independent judgment, and is reviewed through audits of work product and reports and through personal conferences. The specialist investigates claims submitted by state employees, applies applicable laws, and determines compensability. The role includes evaluating medical reports, authorizing medical treatment, determining rehabilitation needs, authorizing compensation payments and settlements, calculating and maintaining monetary reserves, and pursuing recoveries through subrogation or the Special Disability Trust Fund. The specialist directs defense activity on claims assigned to defense counsel, attends formal workers' compensation mediations and hearings when needed, and advises claims coordinators at state agencies and universities on coverage, compensability, medical treatment, and reporting work-related accidents. As needed, the specialist monitors Risk Management service vendors and completes required DWC forms for Electronic Data Interchange Reporting. Other related work may be assigned. The position is in Tallahassee, Florida.
Requirements
- At least six months of experience in a position requiring working knowledge of Chapter 440, Florida Statutes, or an equivalent statute.
- Knowledge of effective communication principles and techniques.
- Ability to examine and evaluate data relating to a workers' compensation program.
- Ability to understand and apply rules, regulations, policies, and procedures relating to a workers' compensation program.
- Ability to handle telephone calls in a fast, courteous, and effective manner and deal tactfully and courteously with the public.
- Ability to work independently and use problem-solving techniques.
- Ability to conduct fact-finding investigations.
- Ability to plan, organize, and coordinate work assignments.
- Ability to communicate effectively and 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.
- Successful completion of a security background check, including fingerprinting, as a condition of employment.
Nice To Haves
- Current or previous Florida Adjuster License.
- At least one year of experience adjusting workers' compensation claims within the last three years.
- At least one year working in the workers' compensation insurance claims business.
- At least one year working in the workers' compensation insurance claims business in Florida.
- Experience with risk management information systems and/or software designed to assist with adjusting workers' compensation claims.
- Experience adjusting permanent total disability claims or presumption claims.
- Bachelor's degree from an accredited college or university.
Responsibilities
- Conduct detailed investigations of workers' compensation claims submitted by state employees and determine compensability under applicable laws.
- Evaluate medical reports, authorize medical treatment, determine whether rehabilitation is needed, and authorize compensation payments and settlements.
- Calculate and maintain appropriate monetary reserves on claims.
- Recognize and pursue recoveries through subrogation or the Special Disability Trust Fund.
- Direct defense activity on claims assigned to defense counsel in accordance with sound claims-handling principles.
- Attend formal workers' compensation mediations and hearings when necessary.
- Assist and advise claims coordinators at state agencies and universities on workers' compensation coverage, compensability, medical treatment, and reporting work-related accidents.
- Monitor the activities of Risk Management service vendors as needed.
- Complete DWC forms required for Electronic Data Interchange Reporting accurately and on time.
- Perform other related work as required.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
