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Subrogation Program Specialist
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Claims Adjuster - Fort Lauderdale, United States - Remas Staffing
Description
Job Description
Job DescriptionCLAIMS ADJUSTER GENERAL DESCRIPTION:
Performs advanced specialized technical work in the investigation and adjustment of public liability and/or Workers' Compensation claims. Works under general supervision, independently developing work methods and sequences.
GENERAL DUTIES AND RESPONSIBILITIES:
The functions listed below are those that represent the majority of the time spent working in this class. Management may assign additional functions related to the type of work of the job as necessary.
Reviews and analyzes reports of accidents including property damage and bodily injury to determine liability; reviews and analyzes Liability and/or Workers' Compensation claims and recommends appropriate action.
Consults on injury cases with various medical personnel in order to ascertain the extent and cost of treatment, loss of earning capacity and prognosis; confers with County physician on employment limitations.
Performs the calculation and payment of benefits whether indemnity and/or medical benefits, including entering all payments for benefits.Coordinates the gathering of formal evidence by taking photographs, preparing diagrams and making measurements at accident scene; arranges for witnesses to appear at legal proceedings; and prepares accident reports.
For Workers Compensation claims the adjuster will contact the injured employee, employer, and medical provider to document the claim. For Liability claims the adjuster will contact the claimant, the division and any witnesses. Contacts injured employee, employer, and medical provider to document claim.Conducts field investigations, face-to-face statements with employees, employer representatives and witnesses to understand the nature of the claim and gain an understanding of what occurred prior to the claim.
Negotiate claim settlements with the Director of Risk Management, the County Administrator, the County Attorney, claimants and/or their legal teams.
Attend mediations with the County Attorney's office to support the claims process. Provide advice regarding potential fraud, subrogation, and underwriting/safety risk, and communication with counsel.Authorizes/coordinates medical treatment with walk-in facilities and specialists to update claim.
Analyze complex information from different sources, such as police reports, videos from surveillance cameras or audio, and other information to further understand the incident.
Make decisions for approvals of medical treatments and property restoration. Make determinations on liability or compensability for Workers Compensation claims.Apportion percentage of liability and negotiate settlement with claimant or claimant's attorney or Liability ClaimsMonitors/obtains discharge papers for impairment ratings and issues benefits when owed and paid within mandated timeframe to avoid penalties.
Sets up medical only claims to document/update current work status and treatment. Monitors work status for a disability of 7 days or less through discharge for closing a claim. Processes employee-received notices of outstanding medical bills to resolve non-payment issues. Reviews/corrects reporting by Center for Medicare/Medicaid Services (CMS) for accuracy. Denies/processes claims for non-work-related injuries with timely electronic filing to avoid penalties.The Workers Compensation Adjuster calculates/processes disability benefits for impairment ratings of 1% or more when issuing benefits to avoid penalties.
Sets up medical claims to document/update current work status and treatment.Monitors/obtains medical records and work status to ensure timely calculation and payment of indemnity and impairment ratings, complete State EDI mandated reporting within regulated time frames to avoid penalties.
Processes employee-received notices of outstanding medical bills to resolve non-payment issues. Reviews/corrects reporting by Center of Medicare/Medicaid Services (CMS) for accuracy. For disability more than 8 days, initiates timely electronic filings to Division of Workers' Compensation. Conducts recorded interviews with employees and witnesses. Attends meetings with other Divisions, Professional Standards/Human Rights Section (PS/HRS), and Human Resources to discuss complex claims. Performs related work as assigned.MINIMUM EDUCATION AND EXPERIENCE REQUIREMENTS:
Requires two (2) years equivalent of higher-level education from an accredited college or university with major coursework in insurance, risk management, or closely related field.
(One year of relevant experience may be substituted for each year of required education.) Requires four (4) years in adjusting workers' compensation and/or bodily injury/property damage liability claims or closely related experience.
SPECIAL CERTIFICATIONS AND LICENSES:
Possession/retention of a Florida All-Lines Adjuster's License (Type 6-20 or 7-20) from the State of Florida Division of Insurance Agent and Agency Services.
Must possess and maintain a valid Florida Class E Driver's License for duration of appointment
