WORKERS' COMPENSATION CLAIMS ADJUSTER

POSITION GOAL

The Workers’ Compensation Claims Adjuster is responsible for first-line claims handling including benefit determination based on the interpretation of statutory provisions, legal precedence, regulatory rules, and administrative policy and procedure.  This position is responsible for managing the financial, legal, statutory/ regulatory, and administrative activities related to an assigned inventory of individual claims. 

ESSENTIAL PERFORMANCE RESPONSIBILITIES

The Workers’ Compensation Claims Adjuster shall carry out the performance responsibilities listed below:

• Serve as custodian of intellectual integrity of the District’s workers’ compensation program core principles.
• Build a strong partnership with paired medical case manager in order to support and integrate the delivery of medical services into the overall claim strategy.
• Investigate, on an ongoing basis, the facts, and circumstances of individual claims in order to appropriately deliver on/adjudicate the provision of benefits.
• Develop individual claim action plans in order to bring claims to appropriate closure.
• Identify specific claim issues encountered during daily claims management operations, determine appropriate solutions, and reach collaborative resolution of issues.
• Manage assigned inventory of claims to appropriate closure through the application of pro-active litigation management.
• Manage assigned inventory of claims to appropriate closure through the application of financial management techniques relative to including but not limited to; individual case reserving, determination of proper average weekly wage, settlement evaluation, reporting of excess losses to the District’s excess carrier, third-party recoveries/subrogation, etc.
• Manage compliance with statutes and regulation as well as other administrative processes including but not limited to; major contributing cause, apportionment of benefits, system fraud and/or abuse.
• Serve as the conduit of claim information by documenting and communicating relevant claim activity within the claims administration system and among appropriate claim parties.
• Gather evidence and conduct investigations in order to make appropriate determinations regarding initial and ongoing coverage and compensability including medical causality.
• Gather evidence and conduct investigations in order to evaluate case facts in order to make determinations regarding denial.
• Utilize appropriate claim diary management practices/actions (scheduling of future claim activities).
• Identify subrogation potential and pursue the process of reimbursement where applicable.
• Analyze, compute, process, and document indemnity (lost wage) payments.
• Identify and escalate individual claims meeting pre-determined criteria, to the claims supervisor.
• Participate in multi-disciplinary team meetings for the purpose of “roundtable” group evaluation, planning, and implementation of case strategy.
• Review claim level data and reports to effectively manage day to day operational activities of an assigned inventory of claims.
• Maintain technical competency and currency through continuous and regular review of relevant industry developments, literature, and other technical sources of information, as well as participation in conferences and other continuing education opportunities.
• and more!

To review this position's complete job description, access the following website: https://www.browardschools.com/Page/36072 and search by Job Code. The Job Code for this position is:  CC-066

MINIMUM QUALIFICATIONS & EXPERIENCE

• A standard high school diploma or satisfactory completion  of an approved General Educational Development (GED) Testing Program. 
• A minimum of two (2) years of experience in workers’ compensation or related fields including but not limited to insurance, finance, or litigation.  
• A Florida 6-24 (workers’ compensation adjuster) license or Florida 6-20 (all lines of insurance) license. 
• Computer skills are required for the position. 

PREFERRED QUALIFICATIONS & EXPERIENCE

• An earned bachelor’s degree from an accredited institution. 
• Three (3) or more years of experience in workers’ compensation or related fields including but not limited to insurance, finance, or litigation. 
• Industry certification/designation (i.e., Chartered Property Casualty Underwriter (CPCU), Associate in Claims (AIC), Certified Workers’ Compensation (CWC), and/or similar industry recognized certification or designation.   
• In depth knowledge of Florida workers’ compensation statutes and regulation and experience in the application of the law and rules. 
• Bilingual skills. 

SIGNIFICANT CONTACTS-frequency, contact, purpose

May occasionally interact with contracted service providers to ensure the District’s workers’ compensation program is consistent with SBBC’s strategic direction, policies, and procedures.  Will regularly communicate with claim stakeholders including but not limited to injured workers, location administrators, physicians and other clinicians, defense and plaintiff counsel, regulators, and others to discuss individual claims tactical information for the purpose of issue or claim resolution. 

PHYSICAL REQUIREMENTS

Light work: Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force as frequently as needed to move objects.

TERMS OF EMPLOYMENT

Salary and benefits shall be paid consistent with the District's approved compensation plan. Length of the work year and hours of employment shall be those established by the School Board.

LINK TO JOB DESCRIPTION

To review this position's complete job description, access the following website: https://www.browardschools.com/Page/36072 and search by Job Code. The Job Code for this position is:  CC-066