Claims Adjuster-Worker's Compensation

Overview The Broward County Board of County Commissioners is seeking qualified candidates for a Workers' Compensation Claims Adjuster in the Risk Management Division. We are seeking a detail-oriented and customer-focused candidate to join our team. Responsibilities Investigate, evaluate, and settle insurance claims in accordance with company policies and regulatory requirements. Work closely with policyholders, legal representatives, and other stakeholders to ensure fair and timely resolution of claims. Contact injured employees, employers, and medical providers to document claims; set up and update medical claims; monitor medical records and work status; and ensure timely calculation and payment of indemnity and impairment ratings. Review and correct reporting by CMS (Centers for Medicare & Medicaid Services) for accuracy. Perform disability calculations and process payments for indemnity and medical benefits; initiate electronic filings for disability more than 8 days when applicable. Coordinate medical treatment, obtain discharge papers, and manage notices of action taken on claims. Process and monitor medical-only claims and non-work-related injury claims to avoid penalties and ensure timely electronic filing. Conduct recorded interviews with employees and witnesses; gather evidence, photographs, diagrams, and measurements for accident investigations as needed. Negotiate claim settlements with stakeholders; attend mediations when required; provide guidance on potential fraud, subrogation, and underwriting/safety risk. Review police reports, medical treatment records, medical bills, and liability/claims information to determine liability and appropriate action. Monitor and maintain claims through the life cycle, including status updates and regulatory reporting within required time frames. Minimum Education and Experience Requires two (2) years of higher-level education in workers' compensation and/or general liability claims adjusting and insurance/risk management. One year of relevant experience may be substituted for each year of required education. Requires four (4) years of experience in adjusting workers' compensation and/or bodily injury/property damage liability claims or closely related experience. Special Certifications and Licenses Florida All-Lines Adjuster's License (Type 6-20 or 7-20) or equivalent from the Florida Division of Insurance Agent and Agency Services. Valid Florida Class E Driver's License for duration of appointment. Preferences Associates in Claims (AIC) Certificate. Certified Insurance Counselor (CIC) or Chartered Property Casualty Underwriter (CPCU). Certification in Workers' Compensation (CWC). Accredited Claims Adjuster (ACA). Bachelor's degree or higher in related field. 2 or more years of experience in recorded statements. 2 or more years of experience responding to Conditional Payment demands from CMS. 2 or more years of experience negotiating workers' compensation lien recoveries. Scope of Work The functions listed represent the majority of time spent; management may assign additional functions as necessary. For Workers' Compensation claims, contact injured employees, employers, and medical providers to document the claim; for Liability claims, contact the claimant, the division, and witnesses. Calculate and process disability benefits for impairment ratings of 1% or more; document/update work status and treatment; monitor medical records and ensure timely payment. Complete State EDI mandated reporting within regulated time frames to avoid penalties. Review and analyze reports and liability or workers' compensation claims; conduct field investigations and obtain evidence to determine liability and appropriate action. Coordinate medical treatment and communications; authorize/coordinate medical treatment; prepare notices and correspondence; review CMS reporting; file electronically as required. Negotiate settlements with County leadership and claimants; attend mediations; advise on fraud, subrogation, and safety risk. Analyze complex information from police reports, surveillance, and other sources to understand incident details; determine liability and compensability; document evidence. Attend meetings with divisions and human resources on complex claims; perform related work as assigned. Work Environment Physical Demands: Sedentary work with occasional walking or standing; may involve up to 10 pounds of force; extensive keyboard use. Unavoidable Hazards: None specified. Special Information County Core Values Collaborates: Building partnerships and working collaboratively with others to meet shared objectives. Customer focus: Building strong customer relationships and delivering customer-centric solutions. Instills trust: Gaining the confidence and trust of others through honesty, integrity, and authenticity. Values differences: Recognizing the value that different perspectives and cultures bring to an organization. ADA Compliance Broward County is an Equal Opportunity Employer committed to inclusion. We provide equal opportunity and reasonable accommodations to qualified persons with disabilities. If you require assistance due to a disability, contact the Professional Standards Section in advance at View phone number on click.appcast.io or email View email address on click.appcast.io to request an accommodation. Emergency and County-wide Responsibilities During emergencies, County employees may be required to work as emergency service workers and respond to disaster-related assignments. All employees must uphold the County's ethics and code of conduct and work with diverse populations. #J-18808-Ljbffr